1275595209 NPI number — BOONE TRAIL EMERGENCY SERVICES INC

Table of content: (NPI 1275595209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275595209 NPI number — BOONE TRAIL EMERGENCY SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOONE TRAIL EMERGENCY SERVICES INC
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:
1275595209
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 760
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LILLINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27546-0760
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-893-7565
Provider Business Mailing Address Fax Number:
910-893-3445

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7016 US 421 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LILLINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-893-3750
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CURRIN
Authorized Official First Name:
TONY
Authorized Official Middle Name:
Authorized Official Title or Position:
RESCUE CHIEF
Authorized Official Telephone Number:
910-893-3750

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1412 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3406746 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0726F . This is a "BLUE CROSS PROVIDER ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 590013108 . This is a "RR MEDICARE PROV. ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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