Provider Demographics
NPI:1326227505
Name:LOW COUNTRY AMBULANCE, LLC
Entity Type:Organization
Organization Name:LOW COUNTRY AMBULANCE, LLC
Other - Org Name:CAROLINA MEDCARE, LOW COUNTRY REGION
Other - Org Type:Other Name
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:FABIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:843-534-3022
Mailing Address - Street 1:PO BOX 6708
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-6708
Mailing Address - Country:US
Mailing Address - Phone:843-662-8887
Mailing Address - Fax:843-662-9920
Practice Address - Street 1:4790 TRADE ST
Practice Address - Street 2:SUITE L
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-2833
Practice Address - Country:US
Practice Address - Phone:843-225-1436
Practice Address - Fax:843-225-0295
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINA MEDCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC235341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC235OtherDHEC AMBUANCE SERVICE