Healthcare Provider Details

I. General information

NPI: 1245763960
Provider Name (Legal Business Name): CORDOVA FIRE RESCUE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 04/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 SEVENTH STREET
CORDOVA NC
28330-8900
US

IV. Provider business mailing address

PO BOX 146
CORDOVA NC
28330-0146
US

V. Phone/Fax

Practice location:
  • Phone: 910-895-9713
  • Fax:
Mailing address:
  • Phone: 910-895-9713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1617
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JEREMY RYAN CHANCE
Title or Position: DEPUTY CHIEF
Credential:
Phone: 910-895-9713