Healthcare Provider Details

I. General information

NPI: 1457782906
Provider Name (Legal Business Name): MEDITAM AMBULANCE SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2013
Last Update Date: 12/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3926 WESLEY ST SUITE 103
MYRTLE BEACH SC
29579-7332
US

IV. Provider business mailing address

3926 WESLEY ST SUITE 103
MYRTLE BEACH SC
29579-7332
US

V. Phone/Fax

Practice location:
  • Phone: 843-236-6001
  • Fax: 843-236-6002
Mailing address:
  • Phone: 843-236-6001
  • Fax: 843-236-6002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT A PIKAART
Title or Position: OWNER
Credential:
Phone: 843-236-6001