Provider Demographics
NPI:1700277639
Name:MED1 NC SERVICES LLC
Entity Type:Organization
Organization Name:MED1 NC SERVICES LLC
Other - Org Name:MED1
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-541-7823
Mailing Address - Street 1:2030 POWERS FERRY RD SE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2823
Mailing Address - Country:US
Mailing Address - Phone:770-541-7823
Mailing Address - Fax:770-850-2164
Practice Address - Street 1:4981 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-3441
Practice Address - Country:US
Practice Address - Phone:910-739-5556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-13
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance