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General NPI Number Information
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NPI Number | 1174621452
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Entity Type | Organization
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Legal Business Name | MEDSHORE AMBULANCE SERVICE
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3038 LEAPHART RD
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-3022
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Country | US
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Telephone | 803-794-8107
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2105
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City | ANDERSON
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State | SC
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Zip | 29622-2105
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Country | US
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Telephone | 864-260-4600
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. GREG L SHORE
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Credential |
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Telephone | 864-264-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 183
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License Number State | SC
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