Provider Demographics
NPI:1003829375
Name:AAA AMBULANCE SERVICE
Entity Type:Organization
Organization Name:AAA AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFCOAT
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:601-264-3581
Mailing Address - Street 1:PO BOX 17889
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-7889
Mailing Address - Country:US
Mailing Address - Phone:601-264-2221
Mailing Address - Fax:601-255-0896
Practice Address - Street 1:100 RAWLS SPRINGS LOOP RD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8491
Practice Address - Country:US
Practice Address - Phone:601-264-2221
Practice Address - Fax:601-255-0896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS001-ALS-PARAMEDIC3416L0300X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00050057Medicaid
MS00050057Medicaid
MSW55018Medicare UPIN