Provider Demographics
NPI:1760615843
Name:SOUTH RIVER MERRIMON FIRE & EMS INC.
Entity Type:Organization
Organization Name:SOUTH RIVER MERRIMON FIRE & EMS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-728-2258
Mailing Address - Street 1:1329 S RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:NC
Mailing Address - Zip Code:28516-6648
Mailing Address - Country:US
Mailing Address - Phone:252-728-2258
Mailing Address - Fax:252-728-7961
Practice Address - Street 1:237 OAKLAND DR
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-4509
Practice Address - Country:US
Practice Address - Phone:843-549-3444
Practice Address - Fax:843-549-3474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-24
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1358341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance