=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154719367
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARKTON EMERGENCY MEDICAL SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/23/2014
-----------------------------------------------------
Last Update Date | 04/23/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19 W. 3RD STREET
-----------------------------------------------------
City | PARKTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28371
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-647-6949
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 268
-----------------------------------------------------
City | PARKTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28371-0268
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-674-6949
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ALBERT HARRY MCMILLAN JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 910-674-6949
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 1191
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------