Provider Demographics
| NPI: | 1376863233 |
|---|---|
| Name: | ENVISION HEALTHCARE SERVICES LLC |
| Entity type: | Organization |
| Organization Name: | ENVISION HEALTHCARE SERVICES LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO/PRESIDENT |
| Authorized Official - Prefix: | MS |
| Authorized Official - First Name: | KIMBERLY |
| Authorized Official - Middle Name: | LATRICE |
| Authorized Official - Last Name: | HASTIE |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 803-236-7424 |
| Mailing Address - Street 1: | 145 HIGHWAY 15-401 BYP W STE 9 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | BENNETTSVILLE |
| Mailing Address - State: | SC |
| Mailing Address - Zip Code: | 29512-4359 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 843-456-5045 |
| Mailing Address - Fax: | 843-868-5020 |
| Practice Address - Street 1: | 145 HIGHWAY 15-401 BYP W STE 9 |
| Practice Address - Street 2: | |
| Practice Address - City: | BENNETTSVILLE |
| Practice Address - State: | SC |
| Practice Address - Zip Code: | 29512-4359 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 803-236-7424 |
| Practice Address - Fax: | 843-868-5020 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2010-06-02 |
| Last Update Date: | 2024-06-10 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 251S00000X | Agencies | Community/Behavioral Health | ||
| No | 253J00000X | Agencies | Foster Care Agency | Group - Multi-Specialty | |
| No | 343900000X | Transportation Services | Non-emergency Medical Transport (VAN) | Group - Multi-Specialty | |
| No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
| No | 246QL0900X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Pathology | Laboratory Management | Group - Multi-Specialty |
| No | 246RP1900X | Technologists, Technicians & Other Technical Service Providers | Technician, Pathology | Phlebotomy | Group - Multi-Specialty |
| No | 247ZC0005X | Technologists, Technicians & Other Technical Service Providers | Technician, Pathology | Clinical Laboratory Director, Non-physician | Group - Multi-Specialty |
