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General NPI Number Information
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NPI Number | 1669837936
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Entity Type | Organization
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Legal Business Name | SOCIETY HILL RESCUE SQUAD
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Dates
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Enumeration Date | 12/30/2015
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Last Update Date | 12/30/2015
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Provider Practice Location Address
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Address Line | 280 S MAIN ST
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City | SOCIETY HILL
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State | SC
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Zip | 29593
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Country | US
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Telephone | 843-250-4436
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 291
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City | SOCIETY HILL
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State | SC
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Zip | 29593-0291
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Country | US
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Telephone | 843-250-4436
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Fax |
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Authorized Official
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Title or Position | PARAMEDIC / ASST CAPTAIN
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Name | CHARLES ALLEN TISDALE
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Credential |
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Telephone | 843-601-5553
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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 | 066
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License Number State | SC
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