Provider Demographics
NPI:1386990547
Name:NESHOBA COUNTY AMBULANCE ENTERPRISE
Entity type:Organization
Organization Name:NESHOBA COUNTY AMBULANCE ENTERPRISE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-663-1360
Mailing Address - Street 1:1001 HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-2161
Mailing Address - Country:US
Mailing Address - Phone:601-663-1260
Mailing Address - Fax:601-663-1491
Practice Address - Street 1:1001 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-2161
Practice Address - Country:US
Practice Address - Phone:601-663-1260
Practice Address - Fax:601-663-1491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport