=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508803313
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF HAVELOCK
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2006
-----------------------------------------------------
Last Update Date | 07/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 HATTERAS AVE
-----------------------------------------------------
City | HAVELOCK
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28532-1939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-444-6441
-----------------------------------------------------
Fax | 252-444-6896
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 368
-----------------------------------------------------
City | HAVELOCK
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28532-0368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-444-6441
-----------------------------------------------------
Fax | 252-444-6896
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FIRE/RESCUE CHIEF
-----------------------------------------------------
Name | MR. RICHARD A ZACCARDELLI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 252-444-6441
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------