Provider Demographics
NPI:1710989256
Name:HORRY COUNTY RESCUE SQUAD INC
Entity Type:Organization
Organization Name:HORRY COUNTY RESCUE SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-248-2900
Mailing Address - Street 1:PO BOX 133
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29528-0133
Mailing Address - Country:US
Mailing Address - Phone:843-248-2900
Mailing Address - Fax:843-488-2327
Practice Address - Street 1:165 HIGHWAY 905
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-6801
Practice Address - Country:US
Practice Address - Phone:843-248-2900
Practice Address - Fax:843-488-2327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC174341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered341600000XTransportation ServicesAmbulance
Not Answered3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC174OtherDHEC AMBULANCE PROVIDER
SCAB0210Medicaid