Provider Demographics
NPI:1053310623
Name:WILLIAMSBURG COUNTY EMS
Entity Type:Organization
Organization Name:WILLIAMSBURG COUNTY EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RENE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR/PARAMEDIC
Authorized Official - Phone:843-355-5195
Mailing Address - Street 1:205 THURGOOD MARSHALL HWY
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-4028
Mailing Address - Country:US
Mailing Address - Phone:843-355-5195
Mailing Address - Fax:
Practice Address - Street 1:5005 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-9154
Practice Address - Country:US
Practice Address - Phone:803-957-7111
Practice Address - Fax:803-957-7115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
SC156341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC500951Medicaid