Healthcare Provider Details

I. General information

NPI: 1023008133
Provider Name (Legal Business Name): EASTERN WAKE EMS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E 3RD ST
WENDELL NC
27591-9745
US

IV. Provider business mailing address

PO BOX 863
LEWISVILLE NC
27023-0863
US

V. Phone/Fax

Practice location:
  • Phone: 919-365-1601
  • Fax: 919-365-1602
Mailing address:
  • Phone: 800-814-5339
  • Fax: 336-766-1279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number1215
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1215
License Number StateNC

VIII. Authorized Official

Name: GARLAND TANT
Title or Position: CHIEF
Credential:
Phone: 919-365-1601