Provider Demographics
NPI:1417966110
Name:LOWER PIEDMONT RESCUE SQUAD
Entity Type:Organization
Organization Name:LOWER PIEDMONT RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRITT
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-476-2113
Mailing Address - Street 1:PO BOX 1245
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-0013
Mailing Address - Country:US
Mailing Address - Phone:843-549-3444
Mailing Address - Fax:843-549-3474
Practice Address - Street 1:307 E HAYNE ST
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:SC
Practice Address - Zip Code:29388-1923
Practice Address - Country:US
Practice Address - Phone:864-476-2113
Practice Address - Fax:864-476-7115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC105341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAB0014Medicaid