Provider Demographics
NPI:1457428146
Name:BERKELEY COUNTY EMS
Entity Type:Organization
Organization Name:BERKELEY COUNTY EMS
Other - Org Name:BERKELEY COUNTY EMERGENCY MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OF EMS
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-934-1818
Mailing Address - Street 1:PO BOX 6122
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-6120
Mailing Address - Country:US
Mailing Address - Phone:843-719-4371
Mailing Address - Fax:843-719-4117
Practice Address - Street 1:223 N. LIVE OAK DRIVE
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-9102
Practice Address - Country:US
Practice Address - Phone:843-719-4180
Practice Address - Fax:914-741-1325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0313416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC502575Medicaid
SCQ258120001Medicare PIN
SCQ258120001Medicare PIN