Provider Demographics
NPI:1558739151
Name:PRIME MED SERVICE INC
Entity Type:Organization
Organization Name:PRIME MED SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:PASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-810-7075
Mailing Address - Street 1:5553 HIGHWAY 145
Mailing Address - Street 2:
Mailing Address - City:SHANNON
Mailing Address - State:MS
Mailing Address - Zip Code:38868-9351
Mailing Address - Country:US
Mailing Address - Phone:662-810-7075
Mailing Address - Fax:662-810-7442
Practice Address - Street 1:5553 HIGHWAY 145
Practice Address - Street 2:
Practice Address - City:SHANNON
Practice Address - State:MS
Practice Address - Zip Code:38868-9351
Practice Address - Country:US
Practice Address - Phone:662-810-7075
Practice Address - Fax:662-810-7442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSLGE 852343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)