Provider Demographics
NPI:1609280890
Name:SPRINGLAKE MEDICAL TRANSPORT, LLC
Entity Type:Organization
Organization Name:SPRINGLAKE MEDICAL TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:NREMT
Authorized Official - Phone:843-464-6700
Mailing Address - Street 1:2904 S HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:MULLINS
Mailing Address - State:SC
Mailing Address - Zip Code:29574-5534
Mailing Address - Country:US
Mailing Address - Phone:843-464-6700
Mailing Address - Fax:843-464-6400
Practice Address - Street 1:2904 S HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:MULLINS
Practice Address - State:SC
Practice Address - Zip Code:29574-5534
Practice Address - Country:US
Practice Address - Phone:843-464-6700
Practice Address - Fax:843-464-6400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport