Healthcare Provider Details

I. General information

NPI: 1508850124
Provider Name (Legal Business Name): CAROLINAS MEDICAL RESPONSE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7683 SIDNEY CHERRY GROVE RD
TABOR CITY NC
28463-8719
US

IV. Provider business mailing address

7683 SIDNEY CHERRY GROVE RD
TABOR CITY NC
28463-8719
US

V. Phone/Fax

Practice location:
  • Phone: 910-649-5830
  • Fax: 910-649-5833
Mailing address:
  • Phone: 910-649-5830
  • Fax: 910-649-5833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number128
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number1537
License Number StateNC

VIII. Authorized Official

Name: MR. LLOYD THOMAS BUFFKIN SR.
Title or Position: PRESIDENT
Credential:
Phone: 910-649-5830