NPIMap

Organization Active NPI

Amite County Medical Services, Inc.

Doing business as Liberty Dental Services

  • Federally Qualified Health Center (FQHC)
  • Liberty, MS
National Provider Identifier
1659693083
Registry record updated Feb 26, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
AMITE COUNTY MEDICAL SERVICES, INC.
Doing business as
Liberty Dental Services
Practice address
102 West Freedom Drive
Liberty, MS 39645
Phone
(601) 657-1236
Fax
(601) 657-9181
NPI assigned
Feb 26, 2010
Last updated
Feb 26, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Pam T. Poole
Title
Executive Director
Phone
(601) 657-4326

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

102 West Freedom Drive
Liberty, MS 39645

Mailing address

PO Box 511
Liberty, MS 39645-0511
Phone (601) 657-1236

Other identifiers 1

IdentifierTypeStateIssuer
09015383MedicaidMS

Other names 1

  • Liberty Dental Services Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Amite County Medical Services Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1267142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1267142400000",
    "number": "1659693083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 511",
            "city": "LIBERTY",
            "state": "MS",
            "postal_code": "396450511",
            "telephone_number": "601-657-1236",
            "fax_number": "601-657-9181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 WEST FREEDOM DRIVE",
            "city": "LIBERTY",
            "state": "MS",
            "postal_code": "39645",
            "telephone_number": "601-657-1236",
            "fax_number": "601-657-9181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMITE COUNTY MEDICAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-26",
        "last_updated": "2010-02-26",
        "status": "A",
        "authorized_official_last_name": "POOLE",
        "authorized_official_first_name": "PAM",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "601-657-4326",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09015383",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Liberty Dental Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Liberty, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.