Provider Demographics
NPI:1093417842
Name:TOWN OF LAKE WACCAMAW
Entity Type:Organization
Organization Name:TOWN OF LAKE WACCAMAW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SASSER
Authorized Official - Suffix:JR
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:910-317-5220
Mailing Address - Street 1:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:LAKE WACCAMAW
Mailing Address - State:NC
Mailing Address - Zip Code:28450-0145
Mailing Address - Country:US
Mailing Address - Phone:910-646-3700
Mailing Address - Fax:
Practice Address - Street 1:203 FLEMINGTON DR
Practice Address - Street 2:
Practice Address - City:LAKE WACCAMAW
Practice Address - State:NC
Practice Address - Zip Code:28450
Practice Address - Country:US
Practice Address - Phone:910-646-4441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance