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General NPI Number Information
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NPI Number | 1598176158
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Entity Type | Organization
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Legal Business Name | LAKESIDE MEDICAL RESPONSE TRI COUNTY, LLC
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Dates
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Enumeration Date | 05/16/2014
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Last Update Date | 03/14/2024
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Provider Practice Location Address
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Address Line | 1801D W EVANS ST STE 110
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City | FLORENCE
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State | SC
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Zip | 29501-3333
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Country | US
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Telephone | 843-571-0702
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Fax | 843-571-0306
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Provider Business Mailing Address
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Address Line | 1937 W PALMETTO ST SUITE 163
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City | FLORENCE
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State | SC
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Zip | 29501-3916
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Country | US
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Telephone | 843-571-0702
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Fax | 843-571-0306
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JAMES MARION MCDUFFIE II
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Credential |
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Telephone | 843-260-0922
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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