Healthcare Provider Details

I. General information

NPI: 1336226034
Provider Name (Legal Business Name): MECKLENBURG EMERGENCY MEDICAL SERVICES AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 WILKINSON BLVD
CHARLOTTE NC
28208
US

IV. Provider business mailing address

PO BOX 741033
ATLANTA GA
30374-1033
US

V. Phone/Fax

Practice location:
  • Phone: 704-943-6000
  • Fax: 704-943-6196
Mailing address:
  • Phone: 704-943-6400
  • Fax: 704-943-6196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number0600621
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number0600621
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0600621
License Number StateNC

VIII. Authorized Official

Name: MR. JOHN PETERSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 704-943-6400