Fair Bluff Fire Department and Rescue Squad, Inc

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

1482 Issued in NC

Legal business name

FAIR BLUFF FIRE DEPARTMENT AND RESCUE SQUAD, INC

Practice address

152 Main St
Fair Bluff, NC 28439-5000

Phone

(910) 649-7099

NPI assigned

Jan 19, 2006

Organization subpart

No

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

Authorized official

Name

Beverly Elliott

Title

Secretary/Treasurer

Phone

(910) 649-7099

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Fair Bluff Fire Dept Rescue EMS Other name

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

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

CLIA laboratory certificates

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

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670457600000",
    "number": "1942280599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 PORTER AVE",
            "city": "SCOTTDALE",
            "state": "PA",
            "postal_code": "156831141",
            "telephone_number": "724-887-6822",
            "fax_number": "724-887-9440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "152 MAIN ST",
            "city": "FAIR BLUFF",
            "state": "NC",
            "postal_code": "284395000",
            "telephone_number": "910-649-7099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIR BLUFF FIRE DEPARTMENT AND RESCUE SQUAD, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-19",
        "last_updated": "2022-12-08",
        "certification_date": "2022-12-06",
        "status": "A",
        "authorized_official_last_name": "ELLIOTT",
        "authorized_official_first_name": "BEVERLY",
        "authorized_official_title_or_position": "SECRETARY/TREASURER",
        "authorized_official_telephone_number": "910-649-7099"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "NC",
            "license": "1482",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3406675",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fair Bluff Fire Dept Rescue EMS",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Fair Bluff Fire Dept Rescue EMS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Patricia Ann Davis
• DBG III LLC (Fair Bluff Assisted Living #2)
• DBG III LLC (Fair Bluff Assisted Living #1)
• Elvington Drug LLC (Elvington Drug)
• Fair Bluff Discount Drug, Inc
• Fair Bluff Medical Clinic PLLC
• Leah Jordan Floyd
• Angiala Mia Guilmette
• Hope Advancement Inc.
• Klaudia Kowalkowska

• Land Ambulance in Fair Bluff, NC
• Providers in Fair Bluff, 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 Dec 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.
• 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.