=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033220090
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEMTA OF THE CAROLINAS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 02/09/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2410 MILLIKAN RD
-----------------------------------------------------
City | CHAPEL HILL
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27516-7409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-304-6638
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 870823
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28289-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-304-6638
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | CHARLEY KARNES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 919-304-6638
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 1582
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------