Healthcare Provider Details

I. General information

NPI: 1891782595
Provider Name (Legal Business Name): MEDSHORE AMBULANCE SERVICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 ELLA ST
ANDERSON SC
29621-4807
US

IV. Provider business mailing address

PO BOX 650458
DALLAS TX
75265-0458
US

V. Phone/Fax

Practice location:
  • Phone: 864-260-4600
  • Fax: 864-260-4575
Mailing address:
  • Phone: 844-597-4911
  • Fax: 866-687-2796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number224
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number7241
License Number StateSC

VIII. Authorized Official

Name: MR. ROBERT A JEWELL
Title or Position: CHIEF REVENUE INTEGRATION OFFICER
Credential:
Phone: 844-597-4911