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General NPI Number Information
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NPI Number | 1598787467
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Entity Type | Organization
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Legal Business Name | FORK RESCUE SQUAD
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8513 HIGHWAY 24
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City | TOWNVILLE
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State | SC
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Zip | 29689
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Country | US
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Telephone | 864-287-4882
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Fax | 864-287-4889
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Provider Business Mailing Address
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Address Line | PO BOX 126
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City | TOWNVILLE
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State | SC
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Zip | 29689
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Country | US
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Telephone | 864-287-4882
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Fax | 864-287-4889
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Authorized Official
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Title or Position | CHAIRMAN OF THE BOARD OF DIRECTOR
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Name | MR. SAMMY BUCHANAN
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Credential |
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Telephone | 864-287-4882
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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 | 061
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License Number State | SC
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