Provider Demographics
NPI:1518455468
Name:MADISON COUNTY CITIZENS SERVICES AGENCY
Entity Type:Organization
Organization Name:MADISON COUNTY CITIZENS SERVICES AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMS-JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-391-1993
Mailing Address - Street 1:PO BOX 1358
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-1358
Mailing Address - Country:US
Mailing Address - Phone:601-391-1993
Mailing Address - Fax:601-391-1997
Practice Address - Street 1:1005 W PEACE ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-5378
Practice Address - Country:US
Practice Address - Phone:601-391-1993
Practice Address - Fax:601-391-1997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)