Organization
AMITE COUNTY MEDICAL SERVICES, INC.
Active
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
Update your record
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