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General NPI Number Information
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NPI Number | 1477612612
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Entity Type | Organization
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Legal Business Name | WILSON TRANSPORT SERVICE LLC
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 729 DAVIS ST
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City | LAKE CITY
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State | SC
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Zip | 29560-4212
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Country | US
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Telephone | 843-374-3402
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Fax | 843-374-3406
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Provider Business Mailing Address
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Address Line | 729 DAVIS STREET
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City | LAKE CITY
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State | SC
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Zip | 29560
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Country | US
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Telephone | 843-374-3402
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Fax | 843-374-3406
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Authorized Official
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Title or Position | OWNER
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Name | NATHANIEL FRANKLYN WILSON
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Credential |
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Telephone | 843-374-3402
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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 | 056
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License Number State | SC
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