Organization
AMITE COUNTY MEDICAL SERVICES, INC.
Active
Other names
Gloster 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
253 EAST MAIN STREET, GLOSTER, MS 39638
(601) 225-4119
(601) 225-4620
Mailing address
PO BOX 427, GLOSTER, MS 39638-0427
(601) 225-4119
(601) 225-4620
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09013203
—
MS
Enumeration date
02/22/2010
Last updated
02/22/2010
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