Provider Demographics
NPI:1770237356
Name:THOMAS, PAMELA (CEO/OWNER)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CEO/OWNER
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CEO/OWNER
Mailing Address - Street 1:8786 N CREEK BLVD APT 10-10
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-7231
Mailing Address - Country:US
Mailing Address - Phone:190-182-6201
Mailing Address - Fax:
Practice Address - Street 1:8786 N CREEK BLVD APT 10-10
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-7231
Practice Address - Country:US
Practice Address - Phone:901-826-2016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1246146343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)