=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225138472
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAURENS COUNTY EMS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2006
-----------------------------------------------------
Last Update Date | 09/15/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 321 S HARPER ST
-----------------------------------------------------
City | LAURENS
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29360-3422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-984-1574
-----------------------------------------------------
Fax | 864-984-0576
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 391
-----------------------------------------------------
City | LAURENS
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29360-0391
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-984-1574
-----------------------------------------------------
Fax | 864-984-0576
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF EMS
-----------------------------------------------------
Name | KEVIN ULDRICK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 864-984-1574
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 086
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------