Provider Demographics
NPI:1497702070
Name:AMERATECH OF NORTH CAROLINA INC
Entity Type:Organization
Organization Name:AMERATECH OF NORTH CAROLINA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:VALECIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS-PIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-655-8332
Mailing Address - Street 1:PO BOX 863
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-0863
Mailing Address - Country:US
Mailing Address - Phone:336-766-4448
Mailing Address - Fax:336-766-1279
Practice Address - Street 1:784 JACOBS RD
Practice Address - Street 2:
Practice Address - City:BOLTON
Practice Address - State:NC
Practice Address - Zip Code:28423-8924
Practice Address - Country:US
Practice Address - Phone:910-655-8332
Practice Address - Fax:910-655-8323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0727ROtherBCBS
NC3406748Medicaid
NC0727ROtherBCBS