Provider Demographics
NPI:1609139492
Name:WILSON PARA-TRANSPORT
Entity Type:Organization
Organization Name:WILSON PARA-TRANSPORT
Other - Org Name:WILSON PARA-TRANSPORT SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:843-939-1088
Mailing Address - Street 1:PO BOX 662
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-0662
Mailing Address - Country:US
Mailing Address - Phone:843-939-1088
Mailing Address - Fax:
Practice Address - Street 1:107 E MILL ST
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-3427
Practice Address - Country:US
Practice Address - Phone:843-939-1088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC056341600000X, 3416L0300X
SC7978343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC056OtherDHEC