Provider Demographics
NPI:1508850124
Name:CAROLINAS MEDICAL RESPONSE, INC.
Entity Type:Organization
Organization Name:CAROLINAS MEDICAL RESPONSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BUFFKIN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:910-649-5830
Mailing Address - Street 1:7683 SIDNEY CHERRY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:TABOR CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28463-8719
Mailing Address - Country:US
Mailing Address - Phone:910-649-5830
Mailing Address - Fax:910-649-5833
Practice Address - Street 1:7683 SIDNEY CHERRY GROVE RD
Practice Address - Street 2:
Practice Address - City:TABOR CITY
Practice Address - State:NC
Practice Address - Zip Code:28463-8719
Practice Address - Country:US
Practice Address - Phone:910-649-5830
Practice Address - Fax:910-649-5833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1537146L00000X
SC128146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC07219OtherBCBS NC PROVIDER ID #
NC3406648Medicaid
SCAB0173Medicaid
SCAB0173Medicaid