Provider Demographics
NPI:1285747949
Name:ASHLEY MEDICAL TRANSPORT SERVICE
Entity type:Organization
Organization Name:ASHLEY MEDICAL TRANSPORT SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RONNIE
Authorized Official - Last Name:ASHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-446-8003
Mailing Address - Street 1:PO BOX 742
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29620-0742
Mailing Address - Country:US
Mailing Address - Phone:864-446-8003
Mailing Address - Fax:864-446-8006
Practice Address - Street 1:940 STEVENSON RD
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29620
Practice Address - Country:US
Practice Address - Phone:864-446-8003
Practice Address - Fax:864-446-8006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC058341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC590006341OtherRAILROAD MCARE PROVIDER #
SCAB0086Medicaid
SCAB0086Medicaid
SC=========OtherSC TAX ID #