MEDICARE: FORT MILL RESCUE SQUAD

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	078	SC

General Provider Information

NPI Number	:	1548253784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT MILL RESCUE SQUAD

Provider Business Mailing Address
First Line	:	PO BOX 1011
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29716-1011
Country	:	US
Telephone Number	:	803-548-1456
Fax Number	:

Provider Business Practice Location Address
First Line	:	216 S WHITE ST
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29715-2154
Country	:	US
Telephone Number	:	803-957-7111
Fax Number	:	803-957-7115

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. TIMOTHY JAMES MCMICHAEL
Credential	:	NREMT-P
Telephone Number	:	803-548-1456

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	05/15/2012

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Directions to “FORT MILL RESCUE SQUAD ” Practice Location

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