Healthcare Provider Details

I. General information

NPI: 1427098714
Provider Name (Legal Business Name): MEDSHORE AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3038 LEAD HART RD
W COLUMBIA SC
29169-3022
US

IV. Provider business mailing address

PO BOX 2105
ANDERSON SC
29622-2105
US

V. Phone/Fax

Practice location:
  • Phone: 803-794-8107
  • Fax: 803-794-8212
Mailing address:
  • Phone: 864-260-4600
  • Fax: 864-260-4575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number083
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. GREG L SHORE
Title or Position: CEO
Credential:
Phone: 864-260-4578