1184662504 NPI number — SEA LEVEL FIRE DEPT RESCUE SQUAD & COMMUNITY CENTER INC.

Table of content: (NPI 1184662504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184662504 NPI number — SEA LEVEL FIRE DEPT RESCUE SQUAD & COMMUNITY CENTER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEA LEVEL FIRE DEPT RESCUE SQUAD & COMMUNITY CENTER INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184662504
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 1308
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALTERBORO
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29488-4509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-549-3444
Provider Business Mailing Address Fax Number:
843-547-3474

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
647 HWY 70 EAST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEALEVEL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28577-0069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-225-7721
Provider Business Practice Location Address Fax Number:
252-225-1101
Provider Enumeration Date:
06/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LAXTON
Authorized Official First Name:
PHILLIP
Authorized Official Middle Name:
WALKER
Authorized Official Title or Position:
EMS DIRECTOR
Authorized Official Telephone Number:
252-225-7721

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: 1357 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3406830 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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