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General NPI Number Information
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NPI Number | 1730441858
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Entity Type | Organization
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Legal Business Name | SOUTHERN URGENT TRANSPORT LLC
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Dates
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Enumeration Date | 06/14/2012
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Last Update Date | 06/14/2012
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Provider Practice Location Address
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Address Line | 216 LABONTE ST. SUITE D
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City | CONWAY
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State | SC
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Zip | 29526
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Country | US
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Telephone | 843-349-0086
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Fax | 843-349-0093
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Provider Business Mailing Address
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Address Line | 216 LABONTE ST. SUITE D
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City | CONWAY
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State | SC
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Zip | 29526
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Country | US
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Telephone | 843-349-0086
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Fax | 843-349-0093
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Authorized Official
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Title or Position | CO
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Name | FARHOD MURADOV
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Credential |
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Telephone | 843-349-0086
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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 | 317
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License Number State | SC
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