Provider Demographics
NPI:1891877171
Name:CHOCOWINITY EMS
Entity Type:Organization
Organization Name:CHOCOWINITY EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-948-2446
Mailing Address - Street 1:PO BOX 574
Mailing Address - Street 2:
Mailing Address - City:CHOCOWINITY
Mailing Address - State:NC
Mailing Address - Zip Code:27817-0574
Mailing Address - Country:US
Mailing Address - Phone:252-948-2446
Mailing Address - Fax:
Practice Address - Street 1:5820 US HIGHWAY 17 S
Practice Address - Street 2:
Practice Address - City:CHOCOWINITY
Practice Address - State:NC
Practice Address - Zip Code:27817-8368
Practice Address - Country:US
Practice Address - Phone:252-948-2446
Practice Address - Fax:252-948-0423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2783080OtherMEDICARE
NC3406886Medicaid
NC0729YOtherBLUE CROSS BLUE SHIELD
NC590014707OtherRAIL ROAD MEDICARE
NC590014707OtherRAIL ROAD MEDICARE