Healthcare Provider Details

I. General information

NPI: 1356378855
Provider Name (Legal Business Name): COUNTY OF CASWELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 COUNTY PARK RD
YANCEYVILLE NC
27379
US

IV. Provider business mailing address

PO BOX 99 208 COUNTY PARK RD
YANCEYVILLE NC
27379-0099
US

V. Phone/Fax

Practice location:
  • Phone: 336-694-5177
  • Fax: 336-694-5738
Mailing address:
  • Phone: 336-694-5177
  • Fax: 336-694-5738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number1361
License Number StateNC

VIII. Authorized Official

Name: BARRY LYNCH
Title or Position: EMS DIRECTOR
Credential:
Phone: 336-694-5177