MEDICARE: CITY OF HANAHAN

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	16701	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	:	1275530032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF HANAHAN

Provider Business Mailing Address
First Line	:	104 BERKELEY SQUARE LN
Second Line	:	PMB 81
City	:	GOOSE CREEK
State	:	SC
Zip	:	29445-2958
Country	:	US
Telephone Number	:	843-572-0155
Fax Number	:	843-572-5584

Provider Business Practice Location Address
First Line	:	1255 YEAMANS HALL RD
Second Line	:
City	:	HANAHAN
State	:	SC
Zip	:	29410-2744
Country	:	US
Telephone Number	:	843-554-4221
Fax Number	:

Authorized Official
Title or Position	:	EMS DIRECTOR
Name	:	MICHAEL BARGERON
Credential	:
Telephone Number	:	843-637-1740

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	03/22/2021

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Directions to “CITY OF HANAHAN ” Practice Location

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