Provider Demographics
NPI:1023099611
Name:GATES COUNTY RESCUE SQUAD, INC
Entity type:Organization
Organization Name:GATES COUNTY RESCUE SQUAD, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:STORMY
Authorized Official - Middle Name:TIM
Authorized Official - Last Name:BUTTS
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:252-357-0388
Mailing Address - Street 1:016 US HIGHWAY 158 EAST
Mailing Address - Street 2:
Mailing Address - City:GATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27938-9441
Mailing Address - Country:US
Mailing Address - Phone:252-357-0388
Mailing Address - Fax:252-357-0141
Practice Address - Street 1:016 US HWY 158 EAST
Practice Address - Street 2:
Practice Address - City:GATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:27938-9441
Practice Address - Country:US
Practice Address - Phone:252-357-0388
Practice Address - Fax:252-357-0141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0370123341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406715Medicaid
NC3406715Medicaid