Provider Demographics
NPI:1083651434
Name:COUNTY OF YADKIN OFFICE OF TREASURER
Entity Type:Organization
Organization Name:COUNTY OF YADKIN OFFICE OF TREASURER
Other - Org Name:YADKIN COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:T
Authorized Official - Last Name:TRIVETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-679-4232
Mailing Address - Street 1:PO BOX 998
Mailing Address - Street 2:
Mailing Address - City:YADKINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27055-0998
Mailing Address - Country:US
Mailing Address - Phone:336-679-4232
Mailing Address - Fax:336-679-7646
Practice Address - Street 1:201 CHERRY ST
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:NC
Practice Address - Zip Code:27011-9352
Practice Address - Country:US
Practice Address - Phone:336-679-4232
Practice Address - Fax:336-679-7646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406775Medicaid
NC278074Medicare ID - Type Unspecified