Healthcare Provider Details

I. General information

NPI: 1376580811
Provider Name (Legal Business Name): CITY OF SOUTHPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 08/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N HOWE ST
SOUTHPORT NC
28461-3039
US

IV. Provider business mailing address

PO BOX 747
WHEELING IL
60090-0747
US

V. Phone/Fax

Practice location:
  • Phone: 910-457-7915
  • Fax: 910-457-7904
Mailing address:
  • Phone: 800-244-2354
  • Fax: 800-329-5274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MELANIE TREXLER
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 910-457-7906