Provider Demographics
NPI:1225076813
Name:COUNTY OF SAMPSON
Entity Type:Organization
Organization Name:COUNTY OF SAMPSON
Other - Org Name:SAMPSON COUNTY EMS & RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-592-7181
Mailing Address - Street 1:406 COUNTY COMPLEX RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-4847
Mailing Address - Country:US
Mailing Address - Phone:910-592-7181
Mailing Address - Fax:910-592-5383
Practice Address - Street 1:530 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2241
Practice Address - Country:US
Practice Address - Phone:910-592-8996
Practice Address - Fax:910-592-5383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406958Medicaid
NC2781671Medicare PIN
NC3406958Medicaid