Healthcare Provider Details

I. General information

NPI: 1427154780
Provider Name (Legal Business Name): COUNTY OF COLLETON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 MABEL T WILLIS BLVD
WALTERBORO SC
29488-4522
US

IV. Provider business mailing address

PO BOX 41205
CHARLESTON SC
29423-8068
US

V. Phone/Fax

Practice location:
  • Phone: 843-539-1960
  • Fax: 843-539-1963
Mailing address:
  • Phone: 843-539-1960
  • Fax: 843-539-1963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number115
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number115
License Number StateSC

VIII. Authorized Official

Name: SHEILA COCHRAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 843-539-1960