Provider Demographics
NPI:1780818526
Name:SLADE, CALVIN J SR
Entity Type:Individual
Prefix:
First Name:CALVIN
Middle Name:J
Last Name:SLADE
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1162 ARCH COOK RD
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27311-8746
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1162 ARCH COOK RD
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NC
Practice Address - Zip Code:27311-8746
Practice Address - Country:US
Practice Address - Phone:336-388-0095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC343900000X343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)