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General NPI Number Information
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NPI Number | 1013070382
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Entity Type | Organization
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Legal Business Name | HERBERT STEVEN PRIDGEN
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 10/22/2007
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Provider Practice Location Address
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Address Line | 705 GRANTS CREEK RD
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City | JACKSONVILLE
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State | NC
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Zip | 28546-9644
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Country | US
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Telephone | 910-577-1846
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Fax | 910-577-3429
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Provider Business Mailing Address
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Address Line | 705 GRANTS CREEK RD
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City | JACKSONVILLE
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State | NC
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Zip | 28546-9644
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Country | US
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Telephone | 910-577-1846
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Fax | 910-577-3429
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Authorized Official
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Title or Position | TREASURER
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Name | MRS. PATRICIA JARMAN PRIDGEN
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Credential | EMT I, CFO
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Telephone | 910-577-1846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 1253
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License Number State | NC
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