Provider Demographics
NPI:1881637171
Name:COUNTY OF HERTFORD
Entity type:Organization
Organization Name:COUNTY OF HERTFORD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BROGLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-358-7861
Mailing Address - Street 1:PO BOX 479
Mailing Address - Street 2:102 INDUSTRIAL PARK RD
Mailing Address - City:WINTON
Mailing Address - State:NC
Mailing Address - Zip Code:27986-0479
Mailing Address - Country:US
Mailing Address - Phone:252-358-7861
Mailing Address - Fax:252-358-7899
Practice Address - Street 1:102 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:WINTON
Practice Address - State:NC
Practice Address - Zip Code:27986-0479
Practice Address - Country:US
Practice Address - Phone:252-358-7861
Practice Address - Fax:252-358-7899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0460152341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406752Medicaid
NC3406752Medicaid