Healthcare Provider Details

I. General information

NPI: 1801917166
Provider Name (Legal Business Name): MECKLENBURG COUNTY AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 STATESVILLE RD
CHARLOTTE NC
28269-4249
US

IV. Provider business mailing address

4525 STATESVILLE RD
CHARLOTTE NC
28269-4249
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0600621
License Number StateNC

VIII. Authorized Official

Name: SHELLY FORWARD
Title or Position: FINANCE OFFICER
Credential:
Phone: 704-943-6110