Pembroke Rescue Squad, Inc.

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

1192 Issued in NC

Legal business name

PEMBROKE RESCUE SQUAD, INC.

Practice address

564 Candy Park Rd
Pembroke, NC 28372-1306

Phone

(910) 521-2742

NPI assigned

Jan 19, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Matthew Locklear

Title

Chief

Phone

(910) 521-2742

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Pembroke Rescue Squad Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Tax ID family

Pembroke Rescue Squad Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Pembroke Rescue Squad

  • Ambulance
  • Pembroke, NC
  • NPI 1386634855
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657238400000",
    "number": "1104979368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9150",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420029150",
            "telephone_number": "270-744-9600",
            "fax_number": "270-744-8642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "564 CANDY PARK RD",
            "city": "PEMBROKE",
            "state": "NC",
            "postal_code": "283721306",
            "telephone_number": "910-521-2742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEMBROKE RESCUE SQUAD, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-19",
        "last_updated": "2022-07-08",
        "certification_date": "2022-07-08",
        "status": "A",
        "authorized_official_last_name": "LOCKLEAR",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "CHIEF",
        "authorized_official_telephone_number": "910-521-2742"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "NC",
            "license": "1192",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS/BLUESHIELD NC",
            "identifier": "073CH",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pembroke Rescue Squad",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Pembroke Drug Holdings, LLC
• Pembroke Drug Holdings, LLC
• Pembroke Medical Center, Inc.
• Pembroke Optometric Clinic PA
• Pembroke Rescue Squad
• Devan Tyler Penny, ATS
• Victor Mauricio Pereira Sr., PA-C
• Joseph Perez
• Nichole Eugene Peters
• Jennifer Carol Pickens, MD

• Land Ambulance in Pembroke, NC
• Providers in Pembroke, NC by specialty
• Land Ambulance in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.