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	343900000X	Non-emergency Medical Transport (VAN)
2	341600000X	Ambulance	083	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	:	1427098714
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	:	864-260-4575

Provider Business Practice Location Address
First Line	:	3038 LEAD HART RD
Second Line	:
City	:	W COLUMBIA
State	:	SC
Zip	:	29169-3022
Country	:	US
Telephone Number	:	803-794-8107
Fax Number	:	803-794-8212

Authorized Official
Title or Position	:	CEO
Name	:	MR. GREG L SHORE
Credential	:
Telephone Number	:	864-260-4578

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	12/06/2007

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Directions to “MEDSHORE AMBULANCE SERVICE ” Practice Location

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