MEDICARE: CAROLINA FIRST TRANSPORTATION AMBULANCE OF SOUTH CAROLINA

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	304	SC

General Provider Information

NPI Number	:	1790127355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA FIRST TRANSPORTATION AMBULANCE OF SOUTH CAROLINA

Provider Business Mailing Address
First Line	:	1248 BOILING SPRINGS RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29303-2242
Country	:	US
Telephone Number	:	864-583-3663
Fax Number	:	864-583-3664

Provider Business Practice Location Address
First Line	:	1248 BOILING SPRINGS RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29303-2242
Country	:	US
Telephone Number	:	864-583-3663
Fax Number	:	864-583-3664

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JEREMY FON AHLIJAH
Credential	:
Telephone Number	:	864-583-3663

Provider Enumeration Date	:	07/24/2013
Last Update Date	:	07/24/2013

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