Provider Demographics
NPI:1639359177
Name:ST. JAMES FIRE DEPARTMENT, INC.
Entity Type:Organization
Organization Name:ST. JAMES FIRE DEPARTMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF BOARD OF DIRECTORS
Authorized Official - Prefix:MR
Authorized Official - First Name:WOODROW
Authorized Official - Middle Name:F
Authorized Official - Last Name:CLOOKIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-253-9990
Mailing Address - Street 1:3628 SAINT JAMES DR SE
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-8598
Mailing Address - Country:US
Mailing Address - Phone:910-253-9990
Mailing Address - Fax:910-253-9991
Practice Address - Street 1:3628 SAINT JAMES DR SE
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-8598
Practice Address - Country:US
Practice Address - Phone:910-253-9990
Practice Address - Fax:910-253-9991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCAPPLYING3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2783179Medicare PIN