Provider Demographics
NPI:1184662504
Name:SEA LEVEL FIRE DEPT RESCUE SQUAD & COMMUNITY CENTER INC.
Entity Type:Organization
Organization Name:SEA LEVEL FIRE DEPT RESCUE SQUAD & COMMUNITY CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:WALKER
Authorized Official - Last Name:LAXTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-225-7721
Mailing Address - Street 1:P.O. BOX 1308
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-4509
Mailing Address - Country:US
Mailing Address - Phone:843-549-3444
Mailing Address - Fax:843-547-3474
Practice Address - Street 1:647 HWY 70 EAST
Practice Address - Street 2:
Practice Address - City:SEALEVEL
Practice Address - State:NC
Practice Address - Zip Code:28577-0069
Practice Address - Country:US
Practice Address - Phone:252-225-7721
Practice Address - Fax:252-225-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3416L0300X
NC13573416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406830Medicaid
NC2783084Medicare ID - Type Unspecified
NC2783084Medicare PIN