MEDICARE: COUNTY OF KERSHAW

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	359	SC

General Provider Information

NPI Number	:	1598145237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF KERSHAW

Provider Business Mailing Address
First Line	:	PO BOX 1538
Second Line	:
City	:	LUGOFF
State	:	SC
Zip	:	29078-1538
Country	:	US
Telephone Number	:	803-438-3666
Fax Number	:	803-438-3777

Provider Business Practice Location Address
First Line	:	515 WALNUT ST
Second Line	:
City	:	CAMDEN
State	:	SC
Zip	:	29020-3649
Country	:	US
Telephone Number	:	803-438-3666
Fax Number	:	803-438-3777

Authorized Official
Title or Position	:	COUNTY ADMINISTRATOR
Name	:	VIC CARPENTER
Credential	:
Telephone Number	:	803-425-8220

Provider Enumeration Date	:	06/08/2015
Last Update Date	:	06/27/2016

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Directions to “COUNTY OF KERSHAW ” Practice Location

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