Provider Demographics
NPI:1639112733
Name:PRINCETON RESCUE SQUAD
Entity Type:Organization
Organization Name:PRINCETON RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EDDIE
Authorized Official - Last Name:HADDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-936-3473
Mailing Address - Street 1:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-0326
Mailing Address - Country:US
Mailing Address - Phone:919-936-3473
Mailing Address - Fax:919-936-2814
Practice Address - Street 1:501 WEST US 70 BUS
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NC
Practice Address - Zip Code:27569
Practice Address - Country:US
Practice Address - Phone:919-936-3473
Practice Address - Fax:919-936-2814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406619Medicaid
NC2781846Medicare ID - Type Unspecified