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General NPI Number Information
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NPI Number | 1700337987
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Entity Type | Organization
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Legal Business Name | MEDIC OF SOUTH CAROLINA, LLC
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Dates
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Enumeration Date | 10/22/2016
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Last Update Date | 08/16/2022
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Provider Practice Location Address
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Address Line | 604 E BROAD ST
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City | DARLINGTON
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State | SC
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Zip | 29532
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Country | US
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Telephone | 843-968-9118
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Fax | 843-878-9836
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Provider Business Mailing Address
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Address Line | PO BOX 1335
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City | HARTSVILLE
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State | SC
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Zip | 29551-1335
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Country | US
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Telephone | 843-968-9118
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Fax | 843-878-9836
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHARLES ALLEN TISDALE
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Credential |
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Telephone | 843-968-9118
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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 |
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License Number State |
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