=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043455173
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CUMBERLAND COUNTY EMS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2008
-----------------------------------------------------
Last Update Date | 12/03/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 610 GILLESPIE STREET
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28306-1544
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-609-5600
-----------------------------------------------------
Fax | 910-678-7687
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 610 GILLESPIE STREET
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28306-1544
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-609-5600
-----------------------------------------------------
Fax | 910-678-7687
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EMS DIRECTOR
-----------------------------------------------------
Name | MR. WALLY AINSWORTH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 910-609-5618
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 1067
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------