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General NPI Number Information
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NPI Number | 1508948704
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Entity Type | Organization
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Legal Business Name | WILLIAMSTON RESCUE SQUAD
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 04/09/2008
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Provider Practice Location Address
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Address Line | 902 ANDERSON DR
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City | WILLIAMSTON
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State | SC
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Zip | 29697-1306
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Country | US
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Telephone | 864-847-9584
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Fax | 854-847-9584
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Provider Business Mailing Address
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Address Line | 902 ANDERSON DR
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City | WILLIAMSTON
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State | SC
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Zip | 29697-1306
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Country | US
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Telephone | 864-847-9584
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Fax | 854-847-9584
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. JOSEPH KENNETH BARR JR.
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Credential | EMT-P
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Telephone | 864-847-9584
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343800000X
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Taxonomy Name | Secured Medical Transport (VAN)
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License Number | 7462
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 120
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License Number State | SC
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