Provider Demographics
NPI:1922193218
Name:FRANKLIN AMBULANCE SERVICE
Entity type:Organization
Organization Name:FRANKLIN AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:WENTWORTH
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:601-384-2040
Mailing Address - Street 1:PO BOX 475
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39653
Mailing Address - Country:US
Mailing Address - Phone:601-384-2040
Mailing Address - Fax:601-384-2040
Practice Address - Street 1:46 BUNKLEY ROAD SW
Practice Address - Street 2:MAIN STREET
Practice Address - City:MEADVILLE
Practice Address - State:MS
Practice Address - Zip Code:39653
Practice Address - Country:US
Practice Address - Phone:601-384-2040
Practice Address - Fax:601-384-2040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS036-BASIC LIFE3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
590015574OtherRAILROAD MEDICARE
MS000017407OtherBLUE CROSS/BLUE SHIELD
MS0000117407OtherBCBS
MS00050220Medicaid
590015574OtherRAILROAD MEDICARE
MS00050220Medicaid
590616320Medicare PIN