Healthcare Provider Details

I. General information

NPI: 1427067115
Provider Name (Legal Business Name): WELLFORD RESCUE 21
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 N CRAFT ST
WELLFORD SC
29385-9629
US

IV. Provider business mailing address

PO BOX 1245
WALTERBORO SC
29488-0013
US

V. Phone/Fax

Practice location:
  • Phone: 864-439-7377
  • Fax:
Mailing address:
  • Phone: 843-549-3444
  • Fax: 843-549-3474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number110
License Number StateSC

VIII. Authorized Official

Name: TONIA GIBBS
Title or Position: DIRECTOR
Credential:
Phone: 864-439-7377