Provider Demographics
NPI:1689906463
Name:MARION RESCUE SQUAD INC
Entity Type:Organization
Organization Name:MARION RESCUE SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS/DATA MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHANDLER
Authorized Official - Middle Name:
Authorized Official - Last Name:TISDALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-423-8602
Mailing Address - Street 1:PO BOX 84278
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-0005
Mailing Address - Country:US
Mailing Address - Phone:803-957-7111
Mailing Address - Fax:
Practice Address - Street 1:107 E BOND ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:SC
Practice Address - Zip Code:29571-3627
Practice Address - Country:US
Practice Address - Phone:843-289-2622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC074341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ354930001Medicare PIN