Healthcare Provider Details

I. General information

NPI: 1235257734
Provider Name (Legal Business Name): JOHNSONVILLE RESCUE SQUAD AND AMBULANCE SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 EAST BROADWAY ST
JOHNSONVILLE SC
29555
US

IV. Provider business mailing address

207 EAST BROADWAY ST P O BOX 1021
JOHNSONVILLE SC
29555
US

V. Phone/Fax

Practice location:
  • Phone: 843-386-2821
  • Fax: 843-386-3938
Mailing address:
  • Phone: 843-386-2821
  • Fax: 843-386-3938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number091
License Number StateSC

VIII. Authorized Official

Name: MR. THOMAS E REDMOND
Title or Position: CHIEF
Credential: EMT-P
Phone: 843-386-3511