Provider Demographics
NPI:1962463620
Name:BENHAVEN EMERGENCY SERVICES INC.
Entity Type:Organization
Organization Name:BENHAVEN EMERGENCY SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SWANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-499-9611
Mailing Address - Street 1:200 N 13TH ST
Mailing Address - Street 2:STE. 19A
Mailing Address - City:ERWIN
Mailing Address - State:NC
Mailing Address - Zip Code:28339-1700
Mailing Address - Country:US
Mailing Address - Phone:910-893-7563
Mailing Address - Fax:910-814-2570
Practice Address - Street 1:722 BARBECUE CHURCH RD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332-2255
Practice Address - Country:US
Practice Address - Phone:919-499-9611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12873416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0726QOtherBLUE CROSS PROVIDER ID
NC3406738Medicaid
NC2782919Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID