MEDICARE: WACCAMAW MEDICAL TRANSPORT, 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	341600000X	Ambulance	5101266	NC

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	:	1427234376
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WACCAMAW MEDICAL TRANSPORT, INC.

Provider Business Mailing Address
First Line	:	1935 2ND LOOP RD
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29501-6173
Country	:	US
Telephone Number	:	843-662-8887
Fax Number	:	843-662-9920

Provider Business Practice Location Address
First Line	:	3926 WESLEY ST
Second Line	:	SUITE 202
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-7332
Country	:	US
Telephone Number	:	843-903-5290
Fax Number	:

Authorized Official
Title or Position	:	GENERAL COUNSEL
Name	:	MR. THOMAS MAYNARD SEARS JR.
Credential	:	JD
Telephone Number	:	843-662-8887

Provider Enumeration Date	:	01/10/2008
Last Update Date	:	02/07/2008

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