Healthcare Provider Details

I. General information

NPI: 1578076022
Provider Name (Legal Business Name): DEMARIO SAWYER SR A 1 TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2017
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 SAINT ANDREWS RD
COLUMBIA SC
29210-4167
US

IV. Provider business mailing address

4300 SAINT ANDREWS RD
COLUMBIA SC
29210-4167
US

V. Phone/Fax

Practice location:
  • Phone: 803-828-9460
  • Fax: 855-477-2265
Mailing address:
  • Phone: 803-828-9460
  • Fax: 855-477-2265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number622
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MR. DEMARIO ANDRELL SAWYER
Title or Position: OWNER
Credential:
Phone: 229-393-8667