Healthcare Provider Details

I. General information

NPI: 1538087010
Provider Name (Legal Business Name): MITCH TRANSPORTATION SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6304 BEARS BLUFF RD
WADMALAW ISLAND SC
29487-6808
US

IV. Provider business mailing address

6304 BEARS BLUFF RD
WADMALAW ISLAND SC
29487-6808
US

V. Phone/Fax

Practice location:
  • Phone: 854-202-5076
  • Fax:
Mailing address:
  • Phone: 854-202-5076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name: LANCE MCCLAIR
Title or Position: OPERATION MANAGER
Credential:
Phone: 854-202-5076