Provider Demographics
NPI:1649352998
Name:COLERAIN RESCUE SQUAD INC
Entity type:Organization
Organization Name:COLERAIN RESCUE SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:MR
Authorized Official - First Name:DUNCAN
Authorized Official - Middle Name:PERRY
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-724-2970
Mailing Address - Street 1:P.O. BOX 397
Mailing Address - Street 2:
Mailing Address - City:COLERAIN
Mailing Address - State:NC
Mailing Address - Zip Code:27924-0397
Mailing Address - Country:US
Mailing Address - Phone:252-356-2537
Mailing Address - Fax:252-977-7099
Practice Address - Street 1:110 WINTON ST
Practice Address - Street 2:
Practice Address - City:COLERAIN
Practice Address - State:NC
Practice Address - Zip Code:27924
Practice Address - Country:US
Practice Address - Phone:252-356-2537
Practice Address - Fax:252-977-7099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3416L0300X
NC10203416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406895Medicaid
NC0729XOtherBLUE CROSS BLUE SHIELD
NC=========OtherTRICARE
NC2783094Medicare ID - Type Unspecified