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General NPI Number Information
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NPI Number | 1972595056
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Entity Type | Organization
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Legal Business Name | LAKE ROBINSON RESCUE SQUAD
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2364 W OLD CAMDEN RD
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City | HARTSVILLE
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State | SC
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Zip | 29550-9400
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Country | US
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Telephone | 843-398-4443
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Fax | 843-398-4447
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Provider Business Mailing Address
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Address Line | 1008 HARTSVILLE AIRPORT RD
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City | HARTSVILLE
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State | SC
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Zip | 29550-8459
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Country | US
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Telephone | 843-398-4443
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Fax | 843-398-4447
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. BETTY W TANNER
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Credential | NREMTP
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Telephone | 843-398-4443
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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 | 136
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License Number State | SC
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