Provider Demographics
NPI:1710561493
Name:FORBES, MICHAEL DEMON SR
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DEMON
Last Name:FORBES
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 SHADY LANE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-3529
Mailing Address - Country:US
Mailing Address - Phone:601-918-2462
Mailing Address - Fax:
Practice Address - Street 1:1740 SHADY LANE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3529
Practice Address - Country:US
Practice Address - Phone:601-918-2462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)