MEDICARE: SIX FORKS RESCUE SQUAD, 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	341600000X	Ambulance	1220	NC
2	3416L0300X	Land Ambulance	1220	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
2	07288	OTHER	NC	BCBS OF NC

General Provider Information

NPI Number	:	1992795017
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIX FORKS RESCUE SQUAD, INC.

Provider Business Mailing Address
First Line	:	PO BOX 863
Second Line	:
City	:	LEWISVILLE
State	:	NC
Zip	:	27023-0863
Country	:	US
Telephone Number	:	800-814-5339
Fax Number	:	336-766-1279

Provider Business Practice Location Address
First Line	:	1431 LYNN RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-2427
Country	:	US
Telephone Number	:	919-848-8999
Fax Number	:	919-847-9721

Authorized Official
Title or Position	:	CHIEF
Name	:	THOMAS B JEFFRIES
Credential	:
Telephone Number	:	919-848-8999

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	09/11/2025

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