Provider Demographics
NPI:1609242056
Name:AMITE COUNTY MEDICAL SERVICES, INC.
Entity Type:Organization
Organization Name:AMITE COUNTY MEDICAL SERVICES, INC.
Other - Org Name:PIKE COUNTY MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-657-4326
Mailing Address - Street 1:303 LLEWELLYN AVENUE
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-2866
Mailing Address - Country:US
Mailing Address - Phone:601-249-3541
Mailing Address - Fax:601-249-3544
Practice Address - Street 1:303 LLEWELLYN AVENUE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2866
Practice Address - Country:US
Practice Address - Phone:601-249-3541
Practice Address - Fax:601-249-3544
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMITE COUNTY MEDICAL SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-19
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)