Provider Demographics
NPI:1841251527
Name:ERWIN FIRE DEPARTMENT & RESCUE SQUAD INC
Entity type:Organization
Organization Name:ERWIN FIRE DEPARTMENT & RESCUE SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:W
Authorized Official - Last Name:BLACKMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-897-8151
Mailing Address - Street 1:PO BOX 760
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-0760
Mailing Address - Country:US
Mailing Address - Phone:910-893-7565
Mailing Address - Fax:910-893-3445
Practice Address - Street 1:200 S 13TH ST
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:NC
Practice Address - Zip Code:28339-1706
Practice Address - Country:US
Practice Address - Phone:910-897-8151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARNETT COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-31
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12863416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0726NOtherBLUE CROSS PROVIDER ID
NC3406740Medicaid
NC590013024OtherRR MEDICARE PROV. ID
NC3406740Medicaid