Provider Demographics
NPI:1598787467
Name:FORK RESCUE SQUAD
Entity Type:Organization
Organization Name:FORK RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD OF DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-287-4882
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:TOWNVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29689
Mailing Address - Country:US
Mailing Address - Phone:864-287-4882
Mailing Address - Fax:864-287-4889
Practice Address - Street 1:8513 HIGHWAY 24
Practice Address - Street 2:
Practice Address - City:TOWNVILLE
Practice Address - State:SC
Practice Address - Zip Code:29689
Practice Address - Country:US
Practice Address - Phone:864-287-4882
Practice Address - Fax:864-287-4889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0613416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAB0116Medicaid
Q28095Medicare UPIN