Healthcare Provider Details

I. General information

NPI: 1245400357
Provider Name (Legal Business Name): SOUTHEASTERN MEDICAL TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 GOURDIN ST
SAINT STEPHEN SC
29479-3377
US

IV. Provider business mailing address

120 GOURDIN ST
SAINT STEPHEN SC
29479-3377
US

V. Phone/Fax

Practice location:
  • Phone: 803-460-7107
  • Fax:
Mailing address:
  • Phone: 803-460-7107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. CHRISTOPHER FRANKLIN WEAVER
Title or Position: OWNER
Credential:
Phone: 803-460-7107