=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942698329
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANDERSON COUNTY EMS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2015
-----------------------------------------------------
Last Update Date | 01/07/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 BLECKLEY ST RM. 217
-----------------------------------------------------
City | ANDERSON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29625-4325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-209-1101
-----------------------------------------------------
Fax | 864-716-3679
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 BLECKLEY ST RM. 217
-----------------------------------------------------
City | ANDERSON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29625-4325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-209-1101
-----------------------------------------------------
Fax | 864-716-3679
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. SCOTT STOLLER
-----------------------------------------------------
Credential | NRP
-----------------------------------------------------
Telephone | 864-209-1101
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 264
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------