Provider Demographics
NPI:1821283383
Name:CHOICE TRANSPORT MEDICAL SERVICES
Entity Type:Organization
Organization Name:CHOICE TRANSPORT MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUTTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-664-3239
Mailing Address - Street 1:PO BOX 6194
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29861-6194
Mailing Address - Country:US
Mailing Address - Phone:803-442-9426
Mailing Address - Fax:706-733-1179
Practice Address - Street 1:709 LAKE EDISTO RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-1518
Practice Address - Country:US
Practice Address - Phone:803-664-3239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC239341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAB0268Medicaid
SCAB0268Medicaid