Healthcare Provider Details

I. General information

NPI: 1134179161
Provider Name (Legal Business Name): EASTERN BAND OF CHEROKEE INDIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 10/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

969 ACQUONI ROAD
CHEROKEE NC
28719
US

IV. Provider business mailing address

PO BOX 63303
CHARLOTTE NC
28263-3303
US

V. Phone/Fax

Practice location:
  • Phone: 828-497-1085
  • Fax: 828-497-9554
Mailing address:
  • Phone: 855-626-9660
  • Fax: 937-291-2971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1206
License Number StateNC

VIII. Authorized Official

Name: CORY MATTHEW BLANKENSHIP
Title or Position: SECRETARY OF TREASURY
Credential:
Phone: 828-359-6000