Provider Demographics
NPI:1841399938
Name:MISS-LOU AMBULANCE SERVICE LLC
Entity Type:Organization
Organization Name:MISS-LOU AMBULANCE SERVICE LLC
Other - Org Name:METRO RURAL SERVICES LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-422-7281
Mailing Address - Street 1:PO BOX 965
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39121-0965
Mailing Address - Country:US
Mailing Address - Phone:601-304-5350
Mailing Address - Fax:601-304-5508
Practice Address - Street 1:158 COL JOHN PITCHFORD PKWY
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-5280
Practice Address - Country:US
Practice Address - Phone:601-304-5350
Practice Address - Fax:601-304-5508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1149616Medicaid
MS0553931Medicaid
MS=========OtherBCBS OF MS
LA1149616Medicaid
LA=========0OtherBCBS OF LA
LA1149616Medicaid