MEDICARE: MEDSHORE AMBULANCE SERVICE

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	341600000X	Ambulance	183	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174621452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDSHORE AMBULANCE SERVICE

Provider Business Mailing Address
First Line	:	PO BOX 2105
Second Line	:
City	:	ANDERSON
State	:	SC
Zip	:	29622-2105
Country	:	US
Telephone Number	:	864-260-4600
Fax Number	:

Provider Business Practice Location Address
First Line	:	3038 LEAPHART RD
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29169-3022
Country	:	US
Telephone Number	:	803-794-8107
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. GREG L SHORE
Credential	:
Telephone Number	:	864-264-4600

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/22/2020

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