Provider Demographics
NPI:1295793180
Name:PARABASIC, INC
Entity type:Organization
Organization Name:PARABASIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:OSTRANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-264-2911
Mailing Address - Street 1:238 DAWHOO LAKE RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-8720
Mailing Address - Country:US
Mailing Address - Phone:843-264-2911
Mailing Address - Fax:843-264-2604
Practice Address - Street 1:238 DAWHOO LAKE RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-8720
Practice Address - Country:US
Practice Address - Phone:843-264-2911
Practice Address - Fax:843-264-2604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC122341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAB0236Medicaid
SCP00295566OtherMEDICARE RR
SCAB0236Medicaid