1326227505 NPI number — LOW COUNTRY AMBULANCE, LLC

Table of content: (NPI 1326227505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326227505 NPI number — LOW COUNTRY AMBULANCE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOW COUNTRY AMBULANCE, LLC
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:
CAROLINA MEDCARE, LOW COUNTRY REGION
Provider Other Organization Name Type Code:
5
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:
1326227505
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6708
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29502-6708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-662-8887
Provider Business Mailing Address Fax Number:
843-662-9920

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4790 TRADE ST
Provider Second Line Business Practice Location Address:
SUITE L
Provider Business Practice Location Address City Name:
NORTH CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29418-2833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-225-1436
Provider Business Practice Location Address Fax Number:
843-225-0295
Provider Enumeration Date:
10/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FABIAN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
KEVIN
Authorized Official Title or Position:
REGIONAL DIRECTOR
Authorized Official Telephone Number:
843-534-3022

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  235 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 235 . This is a "DHEC AMBUANCE SERVICE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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