Provider Demographics
NPI:1992742340
Name:WILDWOOD FIRE AND RESCUE INC.
Entity type:Organization
Organization Name:WILDWOOD FIRE AND RESCUE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS. DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:ROLAND
Authorized Official - Last Name:MAC MAHON
Authorized Official - Suffix:
Authorized Official - Credentials:EMS DIRECTOR-CHIEF
Authorized Official - Phone:252-726-9715
Mailing Address - Street 1:PO BOX 1308
Mailing Address - Street 2:237 OAKLAND DRIVE
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:27488-4509
Mailing Address - Country:US
Mailing Address - Phone:843-549-3444
Mailing Address - Fax:843-549-3474
Practice Address - Street 1:5291 HWY 70 W
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4507
Practice Address - Country:US
Practice Address - Phone:252-726-9715
Practice Address - Fax:252-247-9961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3416L0300X
NC13603416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406862Medicaid
NC2783153Medicare PIN