Provider Demographics
NPI:1932246006
Name:BOILING SPRINGS LIFE SAVING & RESCUE UNIT, INC.
Entity Type:Organization
Organization Name:BOILING SPRINGS LIFE SAVING & RESCUE UNIT, INC.
Other - Org Name:BOILING SPRINGS RESCUE, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-692-9540
Mailing Address - Street 1:650 MCBRAYER HOMESTEAD RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152
Mailing Address - Country:US
Mailing Address - Phone:704-692-9540
Mailing Address - Fax:704-434-9456
Practice Address - Street 1:650 MCBRAYER HOMESTEAD RD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152
Practice Address - Country:US
Practice Address - Phone:704-692-9540
Practice Address - Fax:704-434-9456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10533416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC073C5OtherBCBSNC
NC3406925Medicaid
NC2780004Medicare PIN