Healthcare Provider Details

I. General information

NPI: 1174885305
Provider Name (Legal Business Name): IDI BILLING SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 06/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 WAX MYRTLE DR
FLORENCE SC
29501-6491
US

IV. Provider business mailing address

PO BOX 7003
FLORENCE SC
29502-7003
US

V. Phone/Fax

Practice location:
  • Phone: 843-687-6843
  • Fax:
Mailing address:
  • Phone: 843-687-6843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number StateSC
# 7
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number StateSC

VIII. Authorized Official

Name: KIMBERLY MCLAUGHLIN
Title or Position: MANAGER
Credential: BS
Phone: 757-305-7153