Healthcare Provider Details

I. General information

NPI: 1699694950
Provider Name (Legal Business Name): LEWIS ELMORE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2152 EPPS RD
NEW ZION SC
29111-9450
US

IV. Provider business mailing address

2152 EPPS RD
NEW ZION SC
29111-9450
US

V. Phone/Fax

Practice location:
  • Phone: 803-460-5771
  • Fax:
Mailing address:
  • Phone: 803-460-5771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number004289585
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: