Provider Demographics
NPI:1457319634
Name:CLOVER RESCUE SQUAD, INC.
Entity Type:Organization
Organization Name:CLOVER RESCUE SQUAD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/ 1ST LIEUTENANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-B, MA
Authorized Official - Phone:803-222-1219
Mailing Address - Street 1:114 BETHEL ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CLOVER
Mailing Address - State:SC
Mailing Address - Zip Code:29710-1127
Mailing Address - Country:US
Mailing Address - Phone:803-222-1219
Mailing Address - Fax:803-222-1219
Practice Address - Street 1:114 BETHEL ST STE 101
Practice Address - Street 2:
Practice Address - City:CLOVER
Practice Address - State:SC
Practice Address - Zip Code:29710-1127
Practice Address - Country:US
Practice Address - Phone:803-222-1219
Practice Address - Fax:803-222-1219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC080341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q341380001Medicare PIN