Healthcare Provider Details

I. General information

NPI: 1881656825
Provider Name (Legal Business Name): COATS GROVE FIRE & RESCUE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 N MCKINNLEY STREET
COATS NC
27521
US

IV. Provider business mailing address

PO BOX 760
LILLINGTON NC
27546-0760
US

V. Phone/Fax

Practice location:
  • Phone: 910-897-7575
  • Fax:
Mailing address:
  • Phone: 910-893-7565
  • Fax: 910-893-3445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1285
License Number StateNC

VIII. Authorized Official

Name: MR. KEVIN L JERNIGAN
Title or Position: CHIEF
Credential:
Phone: 910-897-7575