Provider Demographics
NPI:1679062376
Name:MATHIS NET, LLC
Entity type:Organization
Organization Name:MATHIS NET, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:MATHIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-481-1910
Mailing Address - Street 1:1217 S FRONTAGE RD STE B
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-6124
Mailing Address - Country:US
Mailing Address - Phone:601-481-1910
Mailing Address - Fax:601-481-1909
Practice Address - Street 1:1217 S FRONTAGE RD STE B
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-6124
Practice Address - Country:US
Practice Address - Phone:601-481-1910
Practice Address - Fax:601-481-1909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)