Healthcare Provider Details

I. General information

NPI: 1508195389
Provider Name (Legal Business Name): SEVEN LAKES EMERGENCY MEDICAL SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 04/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 7 LKS DR
SEVEN LAKES NC
27376
US

IV. Provider business mailing address

969 7 LKS N
SEVEN LAKES NC
27376-9752
US

V. Phone/Fax

Practice location:
  • Phone: 910-673-3067
  • Fax:
Mailing address:
  • Phone: 910-673-3067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ROBERT L. HAAN
Title or Position: CHIEF
Credential: EMT
Phone: 910-673-8001