Provider Demographics
NPI:1255333548
Name:COUNTY OF JASPER
Entity Type:Organization
Organization Name:COUNTY OF JASPER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:WILBUR
Authorized Official - Middle Name:
Authorized Official - Last Name:DALEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-726-7797
Mailing Address - Street 1:1509 GRAYS HWY
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-5441
Mailing Address - Country:US
Mailing Address - Phone:843-726-7797
Mailing Address - Fax:843-726-7966
Practice Address - Street 1:1509 GRAYS HWY
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-5441
Practice Address - Country:US
Practice Address - Phone:843-726-7797
Practice Address - Fax:843-726-7966
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF JASPER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-01
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1233416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC502389Medicaid
SC502389Medicaid