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General NPI Number Information
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NPI Number | 1487938767
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Entity Type | Organization
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Legal Business Name | THE GREAT FALLS RESCUE SQUAD
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Dates
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Enumeration Date | 10/04/2011
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Last Update Date | 10/04/2011
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Provider Practice Location Address
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Address Line | 560 CHESTER AVE
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City | GREAT FALLS
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State | SC
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Zip | 29055-1208
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Country | US
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Telephone | 803-482-4315
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Fax | 803-482-4989
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Provider Business Mailing Address
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Address Line | PO BOX 371
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City | GREAT FALLS
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State | SC
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Zip | 29055-0371
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Country | US
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Telephone | 803-482-4315
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Fax | 803-482-4989
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Authorized Official
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Title or Position | CAPTAIN
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Name | MR. TERRY D. SIMS
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Credential | FNP-BC, PNP-BC,
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Telephone | 803-482-6258
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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 | 166
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License Number State | SC
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