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Organization
PROVIDENCE
Active
Organization
PROVIDENCE
Active
Other names
providance
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID D SMITH (CEO)
(601) 395-7602
Entity
Organization
Contact information
Practice address
17 DAISY LN, FOXWORTH, MS 39483-4868
(601) 395-7602
Mailing address
17 DAISY LN, FOXWORTH, MS 39483-4868
(601) 395-7602
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
800427553
MS
343900000X
Non-emergency Medical Transport (VAN)
8000427553
MS
347C00000X
Private Vehicle
098765
MS
Other
Enumeration date
11/19/2018
Last updated
11/19/2018
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