Provider Demographics
NPI:1811958572
Name:ANDERSON CREEK EMERGENCY SERVICES INC.
Entity type:Organization
Organization Name:ANDERSON CREEK EMERGENCY SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-497-0395
Mailing Address - Street 1:200 N 13TH ST
Mailing Address - Street 2:SUITE 19A
Mailing Address - City:ERWIN
Mailing Address - State:NC
Mailing Address - Zip Code:28339-1700
Mailing Address - Country:US
Mailing Address - Phone:910-893-7563
Mailing Address - Fax:910-814-2570
Practice Address - Street 1:2980 RAY RD
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NC
Practice Address - Zip Code:28390-7801
Practice Address - Country:US
Practice Address - Phone:910-497-0395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11143416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406773Medicaid
NC0727COtherBLUE CROSS PROVIDER ID
NC590013041OtherRR MEDICARE PROV ID
NC590013041OtherRR MEDICARE PROV ID