County of Davie
Organization Active NPI Land Ambulance · Mocksville, NC
NPI 1790728319 · NPPES record last updated May 21, 2024
Key facts
- NPI
- 1790728319
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- License
- 1077 (NC)
- Legal business name
- COUNTY OF DAVIE
- Practice address
- 114 Doctor Slate Drive
Mocksville, NC 27028-0935 - Phone
- (336) 751-0879
- Fax
- (336) 751-5914
- NPI assigned
- Jun 13, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- COUNTY OF DAVIE
Authorized official
- Name
- Mr. Joseph Ashburn
- Title
- EMS Director
- Phone
- (336) 705-1820
Parent organization (reported in NPPES) 1
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 7
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D0713945 | Davie County Emergency Services | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060928000040 | NC | Part B Supplier - Ambulance Service Supplier | 7416952312 | Practice locations: Mocksville, NC |
National Provider Directory
- Tax ID family
- County of Davie Office of Finance Agent
- Part of
- County of Davie Office of Finance Agent
Locations
114 Dr Slate Dr
Mocksville, NC 27028
Phone (336) 751-0879
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | NC | ||
| Land Ambulance | 3416L0300X | 1077 | NC | Yes |
Addresses
Primary practice location
114 Doctor Slate Drive
Mocksville, NC 27028-0935
Mailing address
114 Doctor Slate Drive
Mocksville, NC 27028-0935
Phone (336) 751-0879
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3406615 | Medicaid | NC |
Other names
- Davie County EMS
Other providers in Mocksville, NC
- Katharine Cornatzer
- Tona F Cornatzer
- Corvin Chiropractic, PC
- Cecil Todd Corvin
- County of Davie
- County of Davie Office of Finance Agent
- County of Davie Office of Finance Agent
- County of Davie Office of Finance Agent
- Amelia Olweean Craver
- Kathy Jones Crotts
All providers in Mocksville, NC · Land Ambulance in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 21, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.