Provider Demographics
NPI:1003706771
Name:EAST MISSISSIPPI TRANSPORTATION SERVICE
Entity type:Organization
Organization Name:EAST MISSISSIPPI TRANSPORTATION SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHANEYRA
Authorized Official - Middle Name:SHARDA
Authorized Official - Last Name:BENNAMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-504-2652
Mailing Address - Street 1:1401 WILLOW BEND DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-6948
Mailing Address - Country:US
Mailing Address - Phone:601-504-2652
Mailing Address - Fax:
Practice Address - Street 1:1401 WILLOW BEND DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-6948
Practice Address - Country:US
Practice Address - Phone:601-504-2652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-05
Last Update Date:2025-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)