Provider Demographics
NPI:1013056639
Name:CITY OF HERNANDO AMBULANCE
Entity Type:Organization
Organization Name:CITY OF HERNANDO AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MAYOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-744-8413
Mailing Address - Street 1:475 W COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-2102
Mailing Address - Country:US
Mailing Address - Phone:662-449-0504
Mailing Address - Fax:662-429-9099
Practice Address - Street 1:475 W COMMERCE ST
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-2102
Practice Address - Country:US
Practice Address - Phone:270-744-8413
Practice Address - Fax:662-429-9099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS046-ADVANCED LIFE SU3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport