MEDICARE: MEDITAM AMBULANCE SERVICE INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	343800000X	Secured Medical Transport (VAN)
2	343900000X	Non-emergency Medical Transport (VAN)
3	344600000X	Taxi
4	3416L0300X	Land Ambulance

General Provider Information

NPI Number	:	1457782906
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDITAM AMBULANCE SERVICE INC

Provider Business Mailing Address
First Line	:	3926 WESLEY ST
Second Line	:	SUITE 103
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-7332
Country	:	US
Telephone Number	:	843-236-6001
Fax Number	:	843-236-6002

Provider Business Practice Location Address
First Line	:	3926 WESLEY ST
Second Line	:	SUITE 103
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-7332
Country	:	US
Telephone Number	:	843-236-6001
Fax Number	:	843-236-6002

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ROBERT A PIKAART
Credential	:
Telephone Number	:	843-236-6001

Provider Enumeration Date	:	12/10/2013
Last Update Date	:	12/10/2013

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Directions to “MEDITAM AMBULANCE SERVICE INC ” Practice Location

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