Provider Demographics
NPI:1013070382
Name:HERBERT STEVEN PRIDGEN
Entity Type:Organization
Organization Name:HERBERT STEVEN PRIDGEN
Other - Org Name:COASTAL AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:JARMAN
Authorized Official - Last Name:PRIDGEN
Authorized Official - Suffix:
Authorized Official - Credentials:EMT I, CFO
Authorized Official - Phone:910-577-1846
Mailing Address - Street 1:705 GRANTS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-9644
Mailing Address - Country:US
Mailing Address - Phone:910-577-1846
Mailing Address - Fax:910-577-3429
Practice Address - Street 1:705 GRANTS CREEK RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-9644
Practice Address - Country:US
Practice Address - Phone:910-577-1846
Practice Address - Fax:910-577-3429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12533416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406781Medicaid
NC2782056Medicare ID - Type Unspecified