Provider Demographics
NPI:1336446681
Name:HILL, LISA DIANA
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:DIANA
Last Name:HILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28663 HIGHWAY 76 E
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-5331
Mailing Address - Country:US
Mailing Address - Phone:864-200-3233
Mailing Address - Fax:
Practice Address - Street 1:28663 HIGHWAY 76 E
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-5331
Practice Address - Country:US
Practice Address - Phone:864-200-3233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC008515702343900000X
SC03012854-9 / 448120343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)