1386038958 NPI number — MEDICONE MEDICAL RESPONSE OF NORTHERN MISSISSIPPI, INC

Table of content: (NPI 1386038958)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386038958 NPI number — MEDICONE MEDICAL RESPONSE OF NORTHERN MISSISSIPPI, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICONE MEDICAL RESPONSE OF NORTHERN MISSISSIPPI, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386038958
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14290 GILLIS RD STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMERS BRANCH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75244-3724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-999-6339
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5226 HACKS CROSS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLIVE BRANCH
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38654-8158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-404-8480
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/23/2015

Additional Information

Authorized Official

Authorized Official Last Name:
REEVES
Authorized Official First Name:
JIM
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/DIRECTOR
Authorized Official Telephone Number:
662-404-8480

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  775 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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