MEDICARE: MINT HILL VOLUNTEER FIRE DEPARTMENT

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	3416L0300X	Land Ambulance	1444	NC

General Provider Information

NPI Number	:	1609201516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINT HILL VOLUNTEER FIRE DEPARTMENT

Provider Business Mailing Address
First Line	:	PO BOX 23065
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28227-0272
Country	:	US
Telephone Number	:	704-545-4866
Fax Number	:

Provider Business Practice Location Address
First Line	:	8313 FAIRVIEW ROAD
Second Line	:
City	:	MINT HILL
State	:	NC
Zip	:	28227-0000
Country	:	US
Telephone Number	:	704-545-4866
Fax Number	:

Authorized Official
Title or Position	:	CHAIRMAN OF THE BOARD
Name	:	JERRY MULLIS
Credential	:
Telephone Number	:	704-545-4866

Provider Enumeration Date	:	09/10/2013
Last Update Date	:	09/10/2013

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