Provider Demographics
NPI:1316047392
Name:PAFFORD MEDICAL SERVICES OF MISSISSIPPI, INC
Entity type:Organization
Organization Name:PAFFORD MEDICAL SERVICES OF MISSISSIPPI, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:CLARK
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 1:901 E SUNFLOWER RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2833
Practice Address - Country:US
Practice Address - Phone:800-451-8036
Practice Address - Fax:870-777-8479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR179410715Medicaid
MS02382301Medicaid
MS02382301Medicaid
AR179410715Medicaid