Provider Demographics
NPI:1760927537
Name:EXODUS MEDICAL TRANSPORT OF SC
Entity Type:Organization
Organization Name:EXODUS MEDICAL TRANSPORT OF SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-601-9801
Mailing Address - Street 1:1117 W HIGHWAY 378
Mailing Address - Street 2:
Mailing Address - City:PAMPLICO
Mailing Address - State:SC
Mailing Address - Zip Code:29583-5346
Mailing Address - Country:US
Mailing Address - Phone:843-601-9801
Mailing Address - Fax:
Practice Address - Street 1:1117 W HIGHWAY 378
Practice Address - Street 2:
Practice Address - City:PAMPLICO
Practice Address - State:SC
Practice Address - Zip Code:29583-5346
Practice Address - Country:US
Practice Address - Phone:843-601-9801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-03
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)