Provider Demographics
NPI:1922045749
Name:NORTH STATE INVESTMENT GROUP, LLC
Entity Type:Organization
Organization Name:NORTH STATE INVESTMENT GROUP, LLC
Other - Org Name:NORTH STATE MEDICAL TRANSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:D
Authorized Official - Last Name:COWARD
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:919-261-8911
Mailing Address - Street 1:1240 CORPORATION PARKWAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1348
Mailing Address - Country:US
Mailing Address - Phone:919-261-8911
Mailing Address - Fax:919-261-8991
Practice Address - Street 1:1240 CORPORATION PARKWAY
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1348
Practice Address - Country:US
Practice Address - Phone:919-261-8911
Practice Address - Fax:919-261-8991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406818Medicaid
NC2783133OtherMEDICARE PTAN
NC3406818Medicaid