Provider Demographics
NPI:1942254479
Name:SELMA RESCUE SQUAD
Entity Type:Organization
Organization Name:SELMA RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEEDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-965-6761
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:NC
Mailing Address - Zip Code:27576-0158
Mailing Address - Country:US
Mailing Address - Phone:919-965-6761
Mailing Address - Fax:919-965-6759
Practice Address - Street 1:210 N WEBB ST
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:NC
Practice Address - Zip Code:27576-2841
Practice Address - Country:US
Practice Address - Phone:919-965-6761
Practice Address - Fax:919-965-6759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406622Medicaid
NC2781891Medicare PIN
NC2781891Medicare ID - Type Unspecified