1114168077 NPI number — NORTH CAROLINA EM-1 MEDICAL SERVICES, PC

Table of content: (NPI 1114168077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114168077 NPI number — NORTH CAROLINA EM-1 MEDICAL SERVICES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH CAROLINA EM-1 MEDICAL SERVICES, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114168077
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
815 S PALAFOX ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENSACOLA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32502-5960
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-444-7009
Provider Business Mailing Address Fax Number:
800-305-3233

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 NORTH MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENANSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-296-0941
Provider Business Practice Location Address Fax Number:
800-305-3233
Provider Enumeration Date:
03/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MEADOWS
Authorized Official First Name:
TERRY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
800-444-7009

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com