Provider Demographics
NPI:1497452346
Name:BROCKINGTON, CALVIN
Entity Type:Individual
Prefix:MR
First Name:CALVIN
Middle Name:
Last Name:BROCKINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 LARK LN
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27803-4225
Mailing Address - Country:US
Mailing Address - Phone:252-314-8546
Mailing Address - Fax:252-822-5111
Practice Address - Street 1:516 LARK LN
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27803-4225
Practice Address - Country:US
Practice Address - Phone:252-314-8546
Practice Address - Fax:252-822-5111
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6402922343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)