Provider Demographics
NPI:1801895230
Name:COUNTY OF PERQUIMANS
Entity type:Organization
Organization Name:COUNTY OF PERQUIMANS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:NIXON
Authorized Official - Suffix:
Authorized Official - Credentials:EMT EMERGENCY SER
Authorized Official - Phone:252-426-5646
Mailing Address - Street 1:PO BOX 563
Mailing Address - Street 2:
Mailing Address - City:HERTFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27944-0563
Mailing Address - Country:US
Mailing Address - Phone:252-426-5646
Mailing Address - Fax:252-426-3306
Practice Address - Street 1:159 CREEK DR
Practice Address - Street 2:
Practice Address - City:HERTFORD
Practice Address - State:NC
Practice Address - Zip Code:27944-9402
Practice Address - Country:US
Practice Address - Phone:910-694-3145
Practice Address - Fax:843-766-4994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC341600000X341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406914Medicaid
NC3406914Medicaid