Provider Demographics
NPI:1427066703
Name:JOHNSTON AMBULANCE SERVICE, INC.
Entity type:Organization
Organization Name:JOHNSTON AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:SUSANNE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-736-3828
Mailing Address - Street 1:2803 US HIGHWAY 70 W
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-9559
Mailing Address - Country:US
Mailing Address - Phone:919-736-3828
Mailing Address - Fax:919-736-7088
Practice Address - Street 1:2803 US HIGHWAY 70 WEST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-9559
Practice Address - Country:US
Practice Address - Phone:919-736-3828
Practice Address - Fax:919-736-7088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC590003478OtherMEDICARE RAILROAD
NC0724GOtherSTATE HEALTH PLAN
NC0724GOtherBCBS PROVIDER NUMBER
NC3406808Medicaid
NC0724GOtherBCBS PROVIDER NUMBER