Provider Demographics
NPI:1821088949
Name:ROLESVILLE EMS, INC.
Entity Type:Organization
Organization Name:ROLESVILLE EMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:COMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-554-3315
Mailing Address - Street 1:PO BOX 863
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-0863
Mailing Address - Country:US
Mailing Address - Phone:800-814-5339
Mailing Address - Fax:336-766-1279
Practice Address - Street 1:204 E YOUNG ST
Practice Address - Street 2:
Practice Address - City:ROLESVILLE
Practice Address - State:NC
Practice Address - Zip Code:27571-9562
Practice Address - Country:US
Practice Address - Phone:919-554-3315
Practice Address - Fax:919-554-3350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1397341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered341600000XTransportation ServicesAmbulance
Not Answered3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00105643OtherRAILROAD MEDICARE
NC3406792Medicaid
NC07287OtherBCBS
NC07287OtherBCBS
NC2783063Medicare ID - Type UnspecifiedMEDICARE