Healthcare Provider Details

I. General information

NPI: 1134898000
Provider Name (Legal Business Name): TOWN OF MONCKS CORNER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 09/13/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 CAROLINA AVE
MONCKS CORNER SC
29461-3735
US

IV. Provider business mailing address

118 CAROLINA AVE
MONCKS CORNER SC
29461-3735
US

V. Phone/Fax

Practice location:
  • Phone: 843-719-7990
  • Fax:
Mailing address:
  • Phone: 843-719-7991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier612
Identifier TypeOTHER
Identifier StateSC
Identifier IssuerEMS AGENCY ID

VIII. Authorized Official

Name: ROBERT GASS
Title or Position: FIRE CHIEF
Credential: EMT
Phone: 843-719-7991