MEDICARE: COUNTY OF DAVIDSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance
2	3416L0300X	Land Ambulance

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	590026353	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	V279AMB	OTHER	PARTNERS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	0722P	OTHER	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1205969292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF DAVIDSON

Provider Business Mailing Address
First Line	:	913 N GREENSBORO ST
Second Line	:
City	:	LEXINGTON
State	:	NC
Zip	:	27292-2699
Country	:	US
Telephone Number	:	336-242-2029
Fax Number	:	336-243-7578

Provider Business Practice Location Address
First Line	:	913 N GREENSBORO ST
Second Line	:
City	:	LEXINGTON
State	:	NC
Zip	:	27292-2699
Country	:	US
Telephone Number	:	336-242-2029
Fax Number	:	336-243-7578

Authorized Official
Title or Position	:	FINANCE DIRECTOR
Name	:	CHRISTY EVERHART STILWELL
Credential	:
Telephone Number	:	336-242-2027

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	08/04/2022

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1336286053 — COUNTY OF DAVIDSON
Practice Location Address:

915 N GREENSBORO ST.
LEXINGTON, NC
27292-2699

Practice Phone: 336-242-2300
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Directions to “COUNTY OF DAVIDSON ” Practice Location

Language	Start Address	Practice Location

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