Provider Demographics
NPI:1326466483
Name:BOOTHE, CONNIE BETH
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:BETH
Last Name:BOOTHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 WALKINGSTICK WAY
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-7224
Mailing Address - Country:US
Mailing Address - Phone:864-593-6148
Mailing Address - Fax:
Practice Address - Street 1:401 WALKINGSTICK WAY
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-7224
Practice Address - Country:US
Practice Address - Phone:864-593-6148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)