Healthcare Provider Details

I. General information

NPI: 1215365127
Provider Name (Legal Business Name): ANDREW KLIE NREMT-P
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2013
Last Update Date: 10/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1448 S LAKE DR
LEXINGTON SC
29073-8356
US

IV. Provider business mailing address

1448 S LAKE DR
LEXINGTON SC
29073-8356
US

V. Phone/Fax

Practice location:
  • Phone: 803-399-8247
  • Fax: 803-399-8230
Mailing address:
  • Phone: 803-399-8247
  • Fax: 803-399-8230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberSC021229
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: