Healthcare Provider Details

I. General information

NPI: 1457688236
Provider Name (Legal Business Name): SAINT MATTHEWS AMBULANCE SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2009
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 TECKLENBURG LN
ST MATTHEWS SC
29135
US

IV. Provider business mailing address

P.O. BOX 738
WALTERBORO SC
29488
US

V. Phone/Fax

Practice location:
  • Phone: 803-957-7111
  • Fax: 803-957-7115
Mailing address:
  • Phone: 803-826-6862
  • Fax: 803-826-6862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: JUDY ANNE BALL
Title or Position: DIRECTOR
Credential:
Phone: 803-378-7940