Organization
AMITE COUNTY MEDICAL SERVICES, INC.
Active
Other names
Liberty Dental Services
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PAM T. POOLE (EXECUTIVE DIRECTOR)
(601) 657-4326
Entity
Organization
Contact information
Practice address
102 WEST FREEDOM DRIVE, LIBERTY, MS 39645
(601) 657-1236
(601) 657-9181
Mailing address
PO BOX 511, LIBERTY, MS 39645-0511
(601) 657-1236
(601) 657-9181
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015383
—
MS
Enumeration date
02/26/2010
Last updated
02/26/2010
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