Provider Demographics
NPI:1285677260
Name:TYRRELL COUNTY AMBULANCE
Entity Type:Organization
Organization Name:TYRRELL COUNTY AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMT
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SAWYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-796-1371
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:NC
Mailing Address - Zip Code:27925-0449
Mailing Address - Country:US
Mailing Address - Phone:252-796-1371
Mailing Address - Fax:252-796-1188
Practice Address - Street 1:108 S WATER ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:NC
Practice Address - Zip Code:27925
Practice Address - Country:US
Practice Address - Phone:252-796-1371
Practice Address - Fax:252-796-1188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406745Medicaid
NC278042Medicare ID - Type Unspecified