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General NPI Number Information
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NPI Number | 1477570273
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Entity Type | Organization
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Legal Business Name | CROFT RESCUE SQUAD, INC
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 985 PATCH DR.
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City | SPARTANBURG
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State | SC
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Zip | 29304
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Country | US
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Telephone | 864-591-1818
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1308 203 B EDDIE CHASTEEN BLVD
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City | WALTERBORO
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State | SC
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Zip | 29488-0032
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Country | US
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Telephone | 843-549-3444
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Fax | 843-549-3474
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Authorized Official
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Title or Position | CAPTAIN
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Name | JIMMY R CORBIN JR.
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Credential | EMT
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Telephone | 864-585-2909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 111
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License Number State | SC
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