Provider Demographics
NPI:1710935036
Name:PROMED AMBULANCE SERVICE, LLC
Entity Type:Organization
Organization Name:PROMED AMBULANCE SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DIRECTOR / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:MCREECE
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:I
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:803-478-6633
Mailing Address - Street 1:1072 PARADISE RD
Mailing Address - Street 2:PO BOX 39
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-6704
Mailing Address - Country:US
Mailing Address - Phone:803-478-6633
Mailing Address - Fax:803-433-7460
Practice Address - Street 1:203 E BOYCE ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-3409
Practice Address - Country:US
Practice Address - Phone:803-478-6633
Practice Address - Fax:803-433-7460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC203341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAB0238Medicaid