MEDICARE: FIRST CHOICE AMBULANCE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	221	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376624171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST CHOICE AMBULANCE, INC.

Provider Business Mailing Address
First Line	:	191 E LOOP RD
Second Line	:
City	:	LAKE CITY
State	:	SC
Zip	:	29560-2172
Country	:	US
Telephone Number	:	843-374-3890
Fax Number	:	843-374-3892

Provider Business Practice Location Address
First Line	:	191 E LOOP RD
Second Line	:
City	:	LAKE CITY
State	:	SC
Zip	:	29560-2172
Country	:	US
Telephone Number	:	843-374-3890
Fax Number	:	843-374-3892

Authorized Official
Title or Position	:	CEO,OWNER
Name	:	MR. JAMES ANTHONY WOODBERRY III
Credential	:
Telephone Number	:	843-374-3890

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	08/22/2020

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