Provider Demographics
NPI:1508948704
Name:WILLIAMSTON RESCUE SQUAD
Entity Type:Organization
Organization Name:WILLIAMSTON RESCUE SQUAD
Other - Org Name:WILLIAMSTON EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:BARR
Authorized Official - Suffix:JR
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:864-847-9584
Mailing Address - Street 1:902 ANDERSON DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:SC
Mailing Address - Zip Code:29697-1306
Mailing Address - Country:US
Mailing Address - Phone:864-847-9584
Mailing Address - Fax:854-847-9584
Practice Address - Street 1:902 ANDERSON DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:SC
Practice Address - Zip Code:29697-1306
Practice Address - Country:US
Practice Address - Phone:864-847-9584
Practice Address - Fax:854-847-9584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC120341600000X
SC7462343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No343800000XTransportation ServicesSecured Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAB0107Medicaid