Provider Demographics
NPI:1134898000
Name:TOWN OF MONCKS CORNER
Entity type:Organization
Organization Name:TOWN OF MONCKS CORNER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GASS
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:843-719-7991
Mailing Address - Street 1:118 CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-3735
Mailing Address - Country:US
Mailing Address - Phone:843-719-7991
Mailing Address - Fax:
Practice Address - Street 1:116 CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3735
Practice Address - Country:US
Practice Address - Phone:843-719-7990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC612OtherEMS AGENCY ID