Healthcare Provider Details

I. General information

NPI: 1154403020
Provider Name (Legal Business Name): PELZER RESCUE SQUAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 LEBBY ST
PELZER SC
29669-1721
US

IV. Provider business mailing address

PO BOX 1934
ANDERSON SC
29622-1934
US

V. Phone/Fax

Practice location:
  • Phone: 864-261-8859
  • Fax:
Mailing address:
  • Phone: 864-261-8859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number004
License Number StateSC

VIII. Authorized Official

Name: MALCOLM E HEATON
Title or Position: A/R SUPERVISOR
Credential:
Phone: 864-261-8859