Healthcare Provider Details

I. General information

NPI: 1164467254
Provider Name (Legal Business Name): TEGA CAY RESCUE SQUAD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 TEGA CAY DR
TEGA CAY SC
29708-9363
US

IV. Provider business mailing address

5000 TEGA CAY DR
TEGA CAY SC
29708-9363
US

V. Phone/Fax

Practice location:
  • Phone: 803-548-2751
  • Fax:
Mailing address:
  • Phone: 803-548-2751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number075
License Number StateSC

VIII. Authorized Official

Name: MR. NORMAN W BALLMER
Title or Position: PRESIDENT
Credential:
Phone: 803-548-2751