Healthcare Provider Details

I. General information

NPI: 1588601470
Provider Name (Legal Business Name): ELIZABETHTOWN RESCUE SQUAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 MERCER RD
ELIZABETHTOWN NC
28337-3939
US

IV. Provider business mailing address

PO BOX 1075
ELIZABETHTOWN NC
28337-1075
US

V. Phone/Fax

Practice location:
  • Phone: 910-862-4036
  • Fax:
Mailing address:
  • Phone: 910-862-4036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ARTHUR A BULLOCK
Title or Position: CHIEF
Credential:
Phone: 910-862-4036