Provider Demographics
NPI:1649557752
Name:IZBICKI, RICHARD ANTHONY
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ANTHONY
Last Name:IZBICKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9783 SOUTH SC HWY 28
Mailing Address - Street 2:POBOX4899
Mailing Address - City:PARKSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29844-4899
Mailing Address - Country:US
Mailing Address - Phone:706-413-2866
Mailing Address - Fax:864-280-9966
Practice Address - Street 1:9783 SC HIGHWAY 28 S
Practice Address - Street 2:
Practice Address - City:PARKSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29845-3436
Practice Address - Country:US
Practice Address - Phone:706-413-2866
Practice Address - Fax:864-280-9966
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC090561672343900000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)