MEDICARE: TEGA CAY RESCUE SQUAD, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	075	SC

General Provider Information

NPI Number	:	1164467254
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEGA CAY RESCUE SQUAD, INC

Provider Business Mailing Address
First Line	:	5000 TEGA CAY DR
Second Line	:
City	:	TEGA CAY
State	:	SC
Zip	:	29708-9363
Country	:	US
Telephone Number	:	803-548-2751
Fax Number	:

Provider Business Practice Location Address
First Line	:	5000 TEGA CAY DR
Second Line	:
City	:	TEGA CAY
State	:	SC
Zip	:	29708-9363
Country	:	US
Telephone Number	:	803-548-2751
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. NORMAN W BALLMER
Credential	:
Telephone Number	:	803-548-2751

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	04/18/2008

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