MEDICARE: LAKE ROBINSON 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	3416L0300X	Land Ambulance	136	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972595056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE ROBINSON RESCUE SQUAD

Provider Business Mailing Address
First Line	:	1008 HARTSVILLE AIRPORT RD
Second Line	:
City	:	HARTSVILLE
State	:	SC
Zip	:	29550-8459
Country	:	US
Telephone Number	:	843-398-4443
Fax Number	:	843-398-4447

Provider Business Practice Location Address
First Line	:	2364 W OLD CAMDEN RD
Second Line	:
City	:	HARTSVILLE
State	:	SC
Zip	:	29550-9400
Country	:	US
Telephone Number	:	843-398-4443
Fax Number	:	843-398-4447

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. BETTY W TANNER
Credential	:	NREMTP
Telephone Number	:	843-398-4443

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	08/22/2020

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Directions to “LAKE ROBINSON RESCUE SQUAD ” Practice Location

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