AMITE COUNTY MEDICAL SERVICES, INC.

Agent

Name	Role	Address
SALLY TOLER	Agent	102 WEST FREEDOM DRIVE, P.O. BOX 511, LIBERTY, MS 39645

Incorporator

Name	Role	Address
ALBERT CAST	Incorporator	P O BOX 363, CROSTY, MS 30000
GERALD MILLER	Incorporator	P O BOX 250, LIBERTY, MS 50000
WINBOURNE SULLIVAN	Incorporator	P O BOX 217, LIBERTY, MS 80000

President

Name	Role	Address
TOM LEWIS	President	P.O. BOX 511, LIBERTY, MS 39645

Vice President

Name	Role	Address
SHAWN FELDER	Vice President	P.O. BOX 511, LIBERTY, MS 39645

Chief Executive Officer

Name	Role	Address
SALLY TOLER	Chief Executive Officer	P.O. BOX 511, LIBERTY, MS 39645

Unique Entity ID

A UEI is a government-provided number, like a tax ID number, that’s used to identify businesses eligible for federal grants, awards and contracts.

Note: In April 2022, the federal government replaced its old identifier of choice, the Data Universal Numbering System (DUNS) number, with a government-issued UEI. Now all the federal government’s Integrated Award Environment systems use UEI numbers instead of DUNS numbers. So any entity doing business with the federal government must register for a UEI.

Business Information

National Provider Identifier

Authorized Person:

Taxonomy:

Contacts:

Filings

Type	Status	Filed Date	Description
Non-Profit Status Report	Filed	2020-09-01	Status Report For AMITE COUNTY MEDICAL SERVICES, INC.
Formation Form	Filed	2004-11-03	Formation
Name Reservation Form	Filed	1978-12-22	Name Reservation

USAspending Awards / Financial Assistance

Tax Exempt