Provider Demographics
NPI:1386038958
Name:MEDICONE MEDICAL RESPONSE OF NORTHERN MISSISSIPPI, INC
Entity Type:Organization
Organization Name:MEDICONE MEDICAL RESPONSE OF NORTHERN MISSISSIPPI, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-404-8480
Mailing Address - Street 1:14290 GILLIS RD STE A
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75244-3724
Mailing Address - Country:US
Mailing Address - Phone:866-999-6339
Mailing Address - Fax:
Practice Address - Street 1:5226 HACKS CROSS RD
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-8158
Practice Address - Country:US
Practice Address - Phone:662-404-8480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-23
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS7753416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport