=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255333548
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY OF JASPER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2005
-----------------------------------------------------
Last Update Date | 11/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1509 GRAYS HWY
-----------------------------------------------------
City | RIDGELAND
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29936-5441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-726-7607
-----------------------------------------------------
Fax | 843-726-7784
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1509 GRAYS HWY
-----------------------------------------------------
City | RIDGELAND
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29936-5441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-726-7607
-----------------------------------------------------
Fax | 843-726-7784
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COUNTY ADMINISTRATOR
-----------------------------------------------------
Name | ANDREW FULGHUM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 843-726-7607
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 123
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------