Healthcare Provider Details

I. General information

NPI: 1255581443
Provider Name (Legal Business Name): NORTH CAROLINA EM I MEDICAL SERVICES P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 03/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 N ROAD ST
ELIZABETH CITY NC
27909-3473
US

IV. Provider business mailing address

PO BOX 37735
PHILADELPHIA PA
19101-5035
US

V. Phone/Fax

Practice location:
  • Phone: 252-384-4610
  • Fax: 252-384-4581
Mailing address:
  • Phone: 727-507-3633
  • Fax: 727-507-3618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. TERRY R MEADOWS
Title or Position: VICE PRESIDENT
Credential: MD
Phone: 727-507-8874