Healthcare Provider Details

I. General information

NPI: 1568662708
Provider Name (Legal Business Name): S&S TRANSPORTATION CONSOLIDATION SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

674 MOORE ST
LAKE CITY SC
29560-4273
US

IV. Provider business mailing address

674 MOORE ST
LAKE CITY SC
29560-4273
US

V. Phone/Fax

Practice location:
  • Phone: 843-206-3997
  • Fax: 843-662-8101
Mailing address:
  • Phone: 843-206-3997
  • Fax: 843-662-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0006X
TaxonomyAmbulatory Fertility Facility
License Number
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateSC

VIII. Authorized Official

Name: MS. GLORIA A. SNOW
Title or Position: PART OWNERSHIP
Credential:
Phone: 843-206-3997