Healthcare Provider Details

I. General information

NPI: 1760927537
Provider Name (Legal Business Name): EXODUS MEDICAL TRANSPORT OF SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 W HIGHWAY 378
PAMPLICO SC
29583-5346
US

IV. Provider business mailing address

1117 W HIGHWAY 378
PAMPLICO SC
29583-5346
US

V. Phone/Fax

Practice location:
  • Phone: 843-601-9801
  • Fax:
Mailing address:
  • Phone: 843-601-9801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER CARRAWAY
Title or Position: OWNER
Credential:
Phone: 843-601-9801