Provider Demographics
NPI:1588605299
Name:TIMMONSVILLE RESCUE SQUAD
Entity Type:Organization
Organization Name:TIMMONSVILLE RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:WINDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-346-7640
Mailing Address - Street 1:401 E MAIN ST
Mailing Address - Street 2:PO BOX 9
Mailing Address - City:TIMMONSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29161-1831
Mailing Address - Country:US
Mailing Address - Phone:843-346-7640
Mailing Address - Fax:843-346-7654
Practice Address - Street 1:401 E MAIN ST
Practice Address - Street 2:
Practice Address - City:TIMMONSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29161-1831
Practice Address - Country:US
Practice Address - Phone:843-346-7640
Practice Address - Fax:843-346-7654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0097341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCABO175Medicaid