Provider Demographics
NPI:1881656825
Name:COATS GROVE FIRE & RESCUE INC
Entity Type:Organization
Organization Name:COATS GROVE FIRE & RESCUE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:JERNIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-897-7575
Mailing Address - Street 1:PO BOX 760
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-0760
Mailing Address - Country:US
Mailing Address - Phone:910-893-7565
Mailing Address - Fax:910-893-3445
Practice Address - Street 1:91 N MCKINNLEY STREET
Practice Address - Street 2:
Practice Address - City:COATS
Practice Address - State:NC
Practice Address - Zip Code:27521
Practice Address - Country:US
Practice Address - Phone:910-897-7575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARNETT COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-05
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12853416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0726LOtherBLUE CROSS PROVIDER ID
NC3406741Medicaid
NC590013110OtherRR MEDICARE PROV. ID
NC0726LOtherBLUE CROSS PROVIDER ID