MEDICARE: SOUTH CAROLINA VIP TOURS LLC

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)		SC

General Provider Information

NPI Number	:	1992144513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH CAROLINA VIP TOURS LLC

Provider Business Mailing Address
First Line	:	3905 W BELTLINE BLVD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-1503
Country	:	US
Telephone Number	:	803-254-6944
Fax Number	:	803-253-6334

Provider Business Practice Location Address
First Line	:	3905 W BELTLINE BLVD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-1503
Country	:	US
Telephone Number	:	803-254-6944
Fax Number	:	803-253-6334

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. DAVID TODD TOOMER
Credential	:
Telephone Number	:	803-254-6944

Provider Enumeration Date	:	06/17/2013
Last Update Date	:	10/08/2014

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