MEDICARE: FAIRMONT AREA EMS & RESCUE

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

General Provider Information

NPI Number	:	1760995591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAIRMONT AREA EMS & RESCUE

Provider Business Mailing Address
First Line	:	1001 S WALNUT ST
Second Line	:
City	:	FAIRMONT
State	:	NC
Zip	:	28340-1843
Country	:	US
Telephone Number	:	248-880-7263
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 S WALNUT ST
Second Line	:
City	:	FAIRMONT
State	:	NC
Zip	:	28340-1843
Country	:	US
Telephone Number	:	248-880-7263
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	RODNEY ALLAN HEASLEY
Credential	:
Telephone Number	:	248-880-7263

Provider Enumeration Date	:	11/15/2017
Last Update Date	:	11/15/2017

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