1508948704 NPI number — WILLIAMSTON RESCUE SQUAD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508948704 NPI number — WILLIAMSTON RESCUE SQUAD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAMSTON RESCUE SQUAD
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:
WILLIAMSTON EMS
Provider Other Organization Name Type Code:
3
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:
1508948704
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
902 ANDERSON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29697-1306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-847-9584
Provider Business Mailing Address Fax Number:
854-847-9584

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
902 ANDERSON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29697-1306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-847-9584
Provider Business Practice Location Address Fax Number:
854-847-9584
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BARR
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
KENNETH
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
864-847-9584

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  120 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 343800000X , with the licence number: 7462 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: AB0107 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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