Healthcare Provider Details

I. General information

NPI: 1710963244
Provider Name (Legal Business Name): PENDLETON AREA RESCUE SQUAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DEPOT STREET
PENDLETON SC
29670
US

IV. Provider business mailing address

PO BOX 185
PENDLETON SC
29670-0185
US

V. Phone/Fax

Practice location:
  • Phone: 864-646-7431
  • Fax: 864-646-7097
Mailing address:
  • Phone: 864-646-7431
  • Fax: 864-646-7097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number006
License Number StateSC

VII. Legacy identifiers

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

# 1
IdentifierAB0084
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name: MR. JAMES LAWRY ALLEN
Title or Position: CHAIRMAN OF THE BOARD OF DIRECTORS
Credential:
Phone: 864-646-7431