Provider Demographics
NPI:1952308785
Name:LEWISTON WOODVILLE VOLUNTEER FIRE AND EMS INC.
Entity Type:Organization
Organization Name:LEWISTON WOODVILLE VOLUNTEER FIRE AND EMS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:WIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-348-2658
Mailing Address - Street 1:PO BOX 431
Mailing Address - Street 2:
Mailing Address - City:LEWISTON WOODVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27849-0431
Mailing Address - Country:US
Mailing Address - Phone:252-348-2658
Mailing Address - Fax:252-348-2608
Practice Address - Street 1:103 WEST CHURCH STREET
Practice Address - Street 2:
Practice Address - City:LEWISTON WOODVILLE
Practice Address - State:NC
Practice Address - Zip Code:27849
Practice Address - Country:US
Practice Address - Phone:252-348-2658
Practice Address - Fax:252-348-2608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00800213416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
3834522OtherCIGNA
NC3406896Medicaid
NC0729WOtherBLUE CROSS/BLUE SHIELD
3834522OtherCIGNA
NC3406896Medicaid