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General NPI Number Information
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NPI Number | 1174882849
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Entity Type | Organization
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Legal Business Name | MOORESVILLE RESCUE SQUAD
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Dates
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Enumeration Date | 05/15/2012
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Last Update Date | 07/25/2012
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Provider Practice Location Address
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Address Line | 204 E. IREDELL AVE.
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City | MOORESVILLE
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State | NC
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Zip | 28115-0000
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Country | US
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Telephone | 704-663-3660
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1109
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City | MOORESVILLE
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State | NC
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Zip | 28115-1109
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Country | US
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Telephone | 704-663-3660
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Fax |
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Authorized Official
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Title or Position | CAPTAIN
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Name | PARISH MOFFITT
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Credential |
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Telephone | 704-663-3660
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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 | 1477
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License Number State | NC
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