=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053624270
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEICESTER VOLUNTEER FIRE DEPARTMENT INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2010
-----------------------------------------------------
Last Update Date | 10/18/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2852 LEICESTER HWY
-----------------------------------------------------
City | LEICESTER
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28748-0000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-683-3433
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 100
-----------------------------------------------------
City | LEICESTER
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28748-0100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-683-3433
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF
-----------------------------------------------------
Name | MR. CHARLES T WILLIAMS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 828-683-3433
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------