Provider Demographics
NPI:1770652604
Name:LAURENS COUNTY
Entity Type:Organization
Organization Name:LAURENS COUNTY
Other - Org Name:LAURENS COUNTY EMS
Other - Org Type:Other Name
Authorized Official - Title/Position:EMS BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:TESSA
Authorized Official - Middle Name:MOSS
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-984-0143
Mailing Address - Street 1:PO BOX 1788
Mailing Address - Street 2:3 CATHERINE STREET
Mailing Address - City:LAURENS
Mailing Address - State:SC
Mailing Address - Zip Code:29360-5044
Mailing Address - Country:US
Mailing Address - Phone:864-984-0143
Mailing Address - Fax:864-984-5863
Practice Address - Street 1:3 CATHERINE ST
Practice Address - Street 2:
Practice Address - City:LAURENS
Practice Address - State:SC
Practice Address - Zip Code:29360-5044
Practice Address - Country:US
Practice Address - Phone:864-984-0143
Practice Address - Fax:864-984-5863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC086261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC502290Medicaid
SC502290Medicaid