Provider Demographics
NPI:1275532855
Name:CITY OF MYRTLE BEACH
Entity Type:Organization
Organization Name:CITY OF MYRTLE BEACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:GWYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-918-1140
Mailing Address - Street 1:921B N OAK ST
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-3500
Mailing Address - Country:US
Mailing Address - Phone:843-918-1192
Mailing Address - Fax:843-918-1204
Practice Address - Street 1:921B N OAK ST
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-3500
Practice Address - Country:US
Practice Address - Phone:846-918-1103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC158341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC502959Medicaid