Healthcare Provider Details

I. General information

NPI: 1053310623
Provider Name (Legal Business Name): WILLIAMSBURG COUNTY EMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 09/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 SUNSET BLVD
LEXINGTON SC
29072-9154
US

IV. Provider business mailing address

205 THURGOOD MARSHALL HWY
KINGSTREE SC
29556-4028
US

V. Phone/Fax

Practice location:
  • Phone: 803-957-7111
  • Fax: 803-957-7115
Mailing address:
  • Phone: 843-355-5195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number156
License Number StateSC

VIII. Authorized Official

Name: RENE C. BRYANT
Title or Position: DIRECTOR
Credential: DIRECTOR/PARAMEDIC
Phone: 843-355-5195