Provider Demographics
NPI:1467708677
Name:ANCILLARY MEDICAL SERVICES
Entity Type:Organization
Organization Name:ANCILLARY MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-727-4780
Mailing Address - Street 1:3309 S LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-4511
Mailing Address - Country:US
Mailing Address - Phone:877-727-4780
Mailing Address - Fax:601-855-2133
Practice Address - Street 1:3309 S LIBERTY ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-4511
Practice Address - Country:US
Practice Address - Phone:877-727-4780
Practice Address - Fax:601-855-2133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy