MEDICARE: TOWN OF INDIAN BEACH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance		NC
2	3416L0300X	Land Ambulance	1238	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518900513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOWN OF INDIAN BEACH

Provider Business Mailing Address
First Line	:	1410 SALTER PATH RD
Second Line	:
City	:	INDIAN BEACH
State	:	NC
Zip	:	28512-5921
Country	:	US
Telephone Number	:	252-247-7994
Fax Number	:

Provider Business Practice Location Address
First Line	:	1410 SALTER PATH RD
Second Line	:
City	:	INDIAN BEACH
State	:	NC
Zip	:	28512-5921
Country	:	US
Telephone Number	:	252-247-7994
Fax Number	:

Authorized Official
Title or Position	:	EMS DIRECTOR
Name	:	JAMES B WHITLEY
Credential	:
Telephone Number	:	252-247-7994

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	09/15/2022

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Directions to “TOWN OF INDIAN BEACH ” Practice Location

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