Provider Demographics
NPI:1043512866
Name:IRON PONY INC
Entity Type:Organization
Organization Name:IRON PONY INC
Other - Org Name:TRUSTUS MEDICAL TRANSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-767-8733
Mailing Address - Street 1:172 ELVINGTON LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-8875
Mailing Address - Country:US
Mailing Address - Phone:803-767-8733
Mailing Address - Fax:803-791-1577
Practice Address - Street 1:1065 HARBOR DR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3609
Practice Address - Country:US
Practice Address - Phone:803-834-3200
Practice Address - Fax:803-791-1577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2773416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport