MEDICARE: VOLUNTEER RESCUE SQUAD OF MYRTLE BEACH 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	341600000X	Ambulance	158	SC

General Provider Information

NPI Number	:	1396794442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VOLUNTEER RESCUE SQUAD OF MYRTLE BEACH INC

Provider Business Mailing Address
First Line	:	5005 SUNSET BLVD
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-9154
Country	:	US
Telephone Number	:	803-957-7111
Fax Number	:	803-957-7115

Provider Business Practice Location Address
First Line	:	3116 SHETLAND LN BLDG UNIT2425
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577
Country	:	US
Telephone Number	:	843-457-0600
Fax Number	:

Authorized Official
Title or Position	:	MD/DIRECTOR
Name	:	VICTORIA ELIZABETH MOSHOURES
Credential	:	MD
Telephone Number	:	843-267-3837

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	05/18/2018

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