NPIMap

Organization Active NPI

County of Surry & Surry County Welfare Department

Doing business as Surry County Emergency Services

  • Land Ambulance
  • Mount Airy, NC
National Provider Identifier
1306843107
Registry record updated Aug 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
License
1204 Issued in NC
Legal business name
COUNTY OF SURRY & SURRY COUNTY WELFARE DEPARTMENT
Doing business as
Surry County Emergency Services
Practice address
1218 State St
Suite 500
Mount Airy, NC 27030-5001
Phone
(336) 783-9000
Fax
(336) 783-9010
NPI assigned
Jul 7, 2005
Last updated
Aug 18, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2016

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

Authorized official

Name
Mrs. Denise N Gray
Title
Administrative Assistant
Phone
(336) 783-9000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Land Ambulance 3416L0300X 1204 NC Primary

Addresses

Primary practice location

1218 State St
Suite 500
Mount Airy, NC 27030-5001

Mailing address

1218 State St
Suite 500
Mount Airy, NC 27030-5001
Phone (336) 783-9000

Other identifiers 6

IdentifierTypeStateIssuer
009010246OtherVIVIRGINIA MEDICAID
590921218OtherNCRAILROAD MEDICARE
V187AMBOtherNCPARTNERS INS & MEDICARE
0723COtherNCBLUE CROSS & BLUE SHIELD
1204OtherALL OTHER INSURANCE CO
3406709MedicaidNC

Other names 1

  • Surry County Emergency Services Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100216000438 NC Part B Supplier - Ambulance Service Supplier 3274550439 Practice locations: Dobson, NC; Elkin, NC; Mount Airy, NC; Pilot Mountain, NC

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D0883037Surry County Emergency Services1218 State Street Suite 500, Mt Airy, NC 27030Certificate of waiverFeb 21, 2028

National Provider Directory

National Provider Directory
Tax ID family
County of Surr Y Surry4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

1218 State St
Ste 500
Mount Airy, NC 27030
Phone (336) 783-9000

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471478400000",
    "number": "1306843107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1218 STATE ST",
            "address_2": "SUITE 500",
            "city": "MOUNT AIRY",
            "state": "NC",
            "postal_code": "270305001",
            "telephone_number": "336-783-9000",
            "fax_number": "336-783-9010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1218 STATE ST",
            "address_2": "SUITE 500",
            "city": "MOUNT AIRY",
            "state": "NC",
            "postal_code": "270305001",
            "telephone_number": "336-783-9000",
            "fax_number": "336-783-9010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF SURRY & SURRY COUNTY WELFARE DEPARTMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-07",
        "last_updated": "2016-08-18",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "DENISE",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "ADMINISTRATIVE ASSISTANT",
        "authorized_official_telephone_number": "336-783-9000",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "NC",
            "license": "1204",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VIRGINIA MEDICAID",
            "identifier": "009010246",
            "state": "VI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "590921218",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARTNERS INS & MEDICARE",
            "identifier": "V187AMB",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "0723C",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALL OTHER INSURANCE CO",
            "identifier": "1204",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3406709",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Surry County Emergency Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Airy, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.