Healthcare Provider Details

I. General information

NPI: 1588605299
Provider Name (Legal Business Name): TIMMONSVILLE RESCUE SQUAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E MAIN ST
TIMMONSVILLE SC
29161-1831
US

IV. Provider business mailing address

401 E MAIN ST PO BOX 9
TIMMONSVILLE SC
29161-1831
US

V. Phone/Fax

Practice location:
  • Phone: 843-346-7640
  • Fax: 843-346-7654
Mailing address:
  • Phone: 843-346-7640
  • Fax: 843-346-7654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number0097
License Number StateSC

VIII. Authorized Official

Name: MR. DONALD E WINDHAM
Title or Position: CHIEF
Credential:
Phone: 843-346-7640