MEDICARE: SELMA RESCUE SQUAD

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		NC

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

General Provider Information

NPI Number	:	1942254479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SELMA RESCUE SQUAD

Provider Business Mailing Address
First Line	:	PO BOX 158
Second Line	:
City	:	SELMA
State	:	NC
Zip	:	27576-0158
Country	:	US
Telephone Number	:	919-965-6761
Fax Number	:	919-965-6759

Provider Business Practice Location Address
First Line	:	210 N WEBB ST
Second Line	:
City	:	SELMA
State	:	NC
Zip	:	27576-2841
Country	:	US
Telephone Number	:	919-965-6761
Fax Number	:	919-965-6759

Authorized Official
Title or Position	:	TREASURER
Name	:	MR. TIMOTHY PEEDIN
Credential	:
Telephone Number	:	919-965-6761

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	07/09/2008

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Directions to “SELMA RESCUE SQUAD ” Practice Location

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