=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639162886
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHESTER COUNTY EMS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2005
-----------------------------------------------------
Last Update Date | 02/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 514 GOVERNMENT DR STE A
-----------------------------------------------------
City | CHESTER
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29706-3619
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-957-7111
-----------------------------------------------------
Fax | 803-957-7115
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 514 GOVERNMENT DR STE A
-----------------------------------------------------
City | CHESTER
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29706-3619
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. JOHN L FAULKNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 803-377-1132
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 017
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------