Provider Demographics
NPI:1295163236
Name:RUTLEDGE, TREVIS
Entity type:Individual
Prefix:
First Name:TREVIS
Middle Name:
Last Name:RUTLEDGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 291203
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-0021
Mailing Address - Country:US
Mailing Address - Phone:803-419-8486
Mailing Address - Fax:803-419-6361
Practice Address - Street 1:7340 PARKLANE RD
Practice Address - Street 2:204 G
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-7644
Practice Address - Country:US
Practice Address - Phone:803-419-8486
Practice Address - Fax:803-419-6361
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport