Healthcare Provider Details

I. General information

NPI: 1992144513
Provider Name (Legal Business Name): SOUTH CAROLINA VIP TOURS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 10/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3905 W BELTLINE BLVD
COLUMBIA SC
29204-1503
US

IV. Provider business mailing address

3905 W BELTLINE BLVD
COLUMBIA SC
29204-1503
US

V. Phone/Fax

Practice location:
  • Phone: 803-254-6944
  • Fax: 803-253-6334
Mailing address:
  • Phone: 803-254-6944
  • Fax: 803-253-6334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateSC

VIII. Authorized Official

Name: MR. DAVID TODD TOOMER
Title or Position: VICE PRESIDENT
Credential:
Phone: 803-254-6944