MEDICARE: KLONDYKE-CHADBOURN VOLUNTEER FIRE & RESCUE INC.

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	1452	NC

General Provider Information

NPI Number	:	1639321144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KLONDYKE-CHADBOURN VOLUNTEER FIRE & RESCUE INC.

Provider Business Mailing Address
First Line	:	PO DRAWER C
Second Line	:
City	:	CHADBOURN
State	:	NC
Zip	:	28431-0000
Country	:	US
Telephone Number	:	910-654-1060
Fax Number	:	910-654-4903

Provider Business Practice Location Address
First Line	:	204 N. WILSON
Second Line	:
City	:	CHADBOURN
State	:	NC
Zip	:	28431-0000
Country	:	US
Telephone Number	:	910-654-1060
Fax Number	:	910-654-4903

Authorized Official
Title or Position	:	CHIEF
Name	:	MR. RANDY GUYTON
Credential	:
Telephone Number	:	910-654-1060

Provider Enumeration Date	:	10/15/2008
Last Update Date	:	10/15/2008

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