Provider Demographics
NPI:1033498217
Name:SOUTH CAROLINA MEDICAL TRANSPORT LLC
Entity Type:Organization
Organization Name:SOUTH CAROLINA MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:B
Authorized Official - Last Name:ELMORE
Authorized Official - Suffix:JR
Authorized Official - Credentials:EMT
Authorized Official - Phone:803-464-2389
Mailing Address - Street 1:6740 ANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DALZELL
Mailing Address - State:SC
Mailing Address - Zip Code:29040-8882
Mailing Address - Country:US
Mailing Address - Phone:803-464-2389
Mailing Address - Fax:
Practice Address - Street 1:6740 ANGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:DALZELL
Practice Address - State:SC
Practice Address - Zip Code:29040-8882
Practice Address - Country:US
Practice Address - Phone:803-464-2389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)