Provider Demographics
NPI:1700503109
Name:PAFFORD AIR OF MISSISSIPPI LLC
Entity Type:Organization
Organization Name:PAFFORD AIR OF MISSISSIPPI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:PAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-451-8036
Mailing Address - Street 1:PO BOX 1120
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:AR
Mailing Address - Zip Code:71802-1120
Mailing Address - Country:US
Mailing Address - Phone:800-451-8036
Mailing Address - Fax:870-777-8479
Practice Address - Street 1:2610 N STATE ST
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-6101
Practice Address - Country:US
Practice Address - Phone:800-451-8036
Practice Address - Fax:870-777-8479
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAFFORD AIR OF MISSISSIPPI LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-26
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR3105858715Medicaid
MS200002376Medicaid