Healthcare Provider Details

I. General information

NPI: 1487938767
Provider Name (Legal Business Name): THE GREAT FALLS RESCUE SQUAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 CHESTER AVE
GREAT FALLS SC
29055-1208
US

IV. Provider business mailing address

PO BOX 371
GREAT FALLS SC
29055-0371
US

V. Phone/Fax

Practice location:
  • Phone: 803-482-4315
  • Fax: 803-482-4989
Mailing address:
  • Phone: 803-482-4315
  • Fax: 803-482-4989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number166
License Number StateSC

VIII. Authorized Official

Name: MR. TERRY D. SIMS
Title or Position: CAPTAIN
Credential: FNP-BC, PNP-BC,
Phone: 803-482-6258