=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770530123
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY OF ANSON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2006
-----------------------------------------------------
Last Update Date | 03/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2230 COUNTRY CLUB RD
-----------------------------------------------------
City | WADESBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28170-0034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-994-3304
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2230 COUNTRY CLUB RD
-----------------------------------------------------
City | WADESBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28170-0034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-694-5342
-----------------------------------------------------
Fax | 704-694-5654
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EMS MANAGER
-----------------------------------------------------
Name | MR. BRIAN NANCE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 704-694-5342
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------