Provider Demographics
NPI:1669816302
Name:MID SOUTH EXPRESS SHUTTLE
Entity type:Organization
Organization Name:MID SOUTH EXPRESS SHUTTLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEARS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:662-420-8402
Mailing Address - Street 1:PO BOX 1988
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-2104
Mailing Address - Country:US
Mailing Address - Phone:662-420-0826
Mailing Address - Fax:662-892-8402
Practice Address - Street 1:4185 SIDLEHILL DR
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-6141
Practice Address - Country:US
Practice Address - Phone:662-420-0826
Practice Address - Fax:662-892-8402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1026-4841343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)