Provider Demographics
NPI:1508195389
Name:SEVEN LAKES EMERGENCY MEDICAL SERVICE, INC.
Entity Type:Organization
Organization Name:SEVEN LAKES EMERGENCY MEDICAL SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAAN
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:910-673-8001
Mailing Address - Street 1:969 7 LKS N
Mailing Address - Street 2:
Mailing Address - City:SEVEN LAKES
Mailing Address - State:NC
Mailing Address - Zip Code:27376-9752
Mailing Address - Country:US
Mailing Address - Phone:910-673-3067
Mailing Address - Fax:
Practice Address - Street 1:714 7 LKS DR
Practice Address - Street 2:
Practice Address - City:SEVEN LAKES
Practice Address - State:NC
Practice Address - Zip Code:27376
Practice Address - Country:US
Practice Address - Phone:910-673-3067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3403826Medicaid
NC3403826Medicaid
P00898219Medicare PIN