Provider Demographics
NPI:1598775751
Name:PIEDMONT TRIAD AMBULANCE & RESCUE INC
Entity Type:Organization
Organization Name:PIEDMONT TRIAD AMBULANCE & RESCUE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:LINEBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-887-3411
Mailing Address - Street 1:PO BOX 534
Mailing Address - Street 2:901 S ELM ST
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27261
Mailing Address - Country:US
Mailing Address - Phone:336-887-3411
Mailing Address - Fax:336-882-5311
Practice Address - Street 1:901 S ELM ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27260
Practice Address - Country:US
Practice Address - Phone:336-887-3411
Practice Address - Fax:336-882-5311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1442341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406765Medicaid
NC3406765Medicaid