Provider Demographics
NPI:1013900257
Name:CALHOUN COUNTY EMS
Entity Type:Organization
Organization Name:CALHOUN COUNTY EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:JR ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:F
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PRICKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-874-2485
Mailing Address - Street 1:201 MILL ST
Mailing Address - Street 2:
Mailing Address - City:ST MATTHEWS
Mailing Address - State:SC
Mailing Address - Zip Code:29135-1340
Mailing Address - Country:US
Mailing Address - Phone:803-655-7625
Mailing Address - Fax:
Practice Address - Street 1:5005 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-9154
Practice Address - Country:US
Practice Address - Phone:803-957-7111
Practice Address - Fax:803-957-7115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC032341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAB0045Medicaid