1801191739 NPI number — PEE DEE MEDICAL TRANSPORT OF SUMTER

Table of content: (NPI 1801191739)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801191739 NPI number — PEE DEE MEDICAL TRANSPORT OF SUMTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEE DEE MEDICAL TRANSPORT OF SUMTER
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:
6
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:
1801191739
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 HUNTERS POND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29229-9003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-840-4235
Provider Business Mailing Address Fax Number:
803-934-9425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1881 S HIGHWAY 14
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29650-4729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-840-4235
Provider Business Practice Location Address Fax Number:
803-934-9425
Provider Enumeration Date:
01/25/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MIDDLETON
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
803-840-4235

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  278 , 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)





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