Provider Demographics
NPI:1942698329
Name:ANDERSON COUNTY EMS
Entity Type:Organization
Organization Name:ANDERSON COUNTY EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:STOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:NRP
Authorized Official - Phone:864-209-1101
Mailing Address - Street 1:200 BLECKLEY ST
Mailing Address - Street 2:RM. 217
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29625-4325
Mailing Address - Country:US
Mailing Address - Phone:864-209-1101
Mailing Address - Fax:864-716-3679
Practice Address - Street 1:200 BLECKLEY ST
Practice Address - Street 2:RM. 217
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29625-4325
Practice Address - Country:US
Practice Address - Phone:864-209-1101
Practice Address - Fax:864-716-3679
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANDERSON COUNTY, SOUTH CAROLINA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2643416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC264OtherSC DHEC EMS AMBULANCE SERVICE LICENSE