Provider Demographics
NPI:1326220443
Name:LUMBERTON RESCUE AND EMERGENCY MEDICAL SERVICE, INC
Entity Type:Organization
Organization Name:LUMBERTON RESCUE AND EMERGENCY MEDICAL SERVICE, INC
Other - Org Name:LUMBERTON EMERGENCY RESCUE UNIT, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-739-8880
Mailing Address - Street 1:409 PORTER AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15683-1141
Mailing Address - Country:US
Mailing Address - Phone:724-887-6822
Mailing Address - Fax:724-887-9440
Practice Address - Street 1:2391 N ROBERTS AVE
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2863
Practice Address - Country:US
Practice Address - Phone:910-738-7275
Practice Address - Fax:910-738-9292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11893416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406689Medicaid
NCP00837262OtherMEDICARE - RAILROAD
NC0726ROtherBLUE CROSS/BLUE SHIELD
NCP00837262OtherMEDICARE - RAILROAD
NC2782607AMedicare PIN