Provider Demographics
NPI:1750474359
Name:SOUTHERN ALTERNATIVE TRANSPORTATION LLC
Entity Type:Organization
Organization Name:SOUTHERN ALTERNATIVE TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:PENDARVIS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:803-829-3433
Mailing Address - Street 1:5877 CHARLESTON HYWY
Mailing Address - Street 2:
Mailing Address - City:BOWMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29018
Mailing Address - Country:US
Mailing Address - Phone:803-829-3433
Mailing Address - Fax:803-829-2794
Practice Address - Street 1:5877 CHARLESTON HYWY
Practice Address - Street 2:
Practice Address - City:BOWMAN
Practice Address - State:SC
Practice Address - Zip Code:29018
Practice Address - Country:US
Practice Address - Phone:803-829-3433
Practice Address - Fax:803-829-2794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7725343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7725OtherSC OFFICE OF REGULATORY