MEDICARE: ANDERSON CREEK EMERGENCY SERVICES INC.

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	1114	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	590013041	OTHER	NC	RR MEDICARE PROV ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0727C	OTHER	NC	BLUE CROSS PROVIDER ID

General Provider Information

NPI Number	:	1811958572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDERSON CREEK EMERGENCY SERVICES INC.

Provider Business Mailing Address
First Line	:	200 N 13TH ST
Second Line	:	SUITE 19A
City	:	ERWIN
State	:	NC
Zip	:	28339-1700
Country	:	US
Telephone Number	:	910-893-7563
Fax Number	:	910-814-2570

Provider Business Practice Location Address
First Line	:	2980 RAY RD
Second Line	:
City	:	SPRING LAKE
State	:	NC
Zip	:	28390-7801
Country	:	US
Telephone Number	:	910-497-0395
Fax Number	:

Authorized Official
Title or Position	:	CHIEF
Name	:	ROBERT J WILSON
Credential	:
Telephone Number	:	910-497-0395

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	02/24/2010

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Directions to “ANDERSON CREEK EMERGENCY SERVICES INC. ” Practice Location

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