Provider Demographics
NPI:1376546788
Name:CHARLESTON COUNTY GOVERNMENT
Entity Type:Organization
Organization Name:CHARLESTON COUNTY GOVERNMENT
Other - Org Name:CHARLESTON COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNTY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-202-6712
Mailing Address - Street 1:PO BOX 100112
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-3112
Mailing Address - Country:US
Mailing Address - Phone:843-202-3722
Mailing Address - Fax:888-965-4620
Practice Address - Street 1:4045 BRIDGE VIEW DR
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-7464
Practice Address - Country:US
Practice Address - Phone:843-202-6722
Practice Address - Fax:843-202-6712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC00153416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC501996Medicaid
SC601154Medicaid
SC501996Medicaid
SCQ254740001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
SC501996Medicaid