Providence

NPI #1821567991 in Foxworth, Mississippi

Provider Information

NPI Number: 1821567991
Entity Type: Organization
Organization Name: Providence
Primary Specialty: Driver
Enumeration Date: Nov 19, 2018
Last Updated: Nov 19, 2018

Practice Location

Address: 17 DAISY LN
City: Foxworth
State: Mississippi
ZIP Code: 39483-4868
Phone: (601) 395-7602

Authorized Official

Name: MR. DAVID D SMITH
Title: CEO
Phone: (601) 395-7602

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Non-emergency Medical Transport (VAN)	343900000X
Private Vehicle	347C00000X
Driver	172A00000X	Primary

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