Provider Demographics
NPI:1669837936
Name:SOCIETY HILL RESCUE SQUAD
Entity type:Organization
Organization Name:SOCIETY HILL RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARAMEDIC / ASST CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:TISDALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-601-5553
Mailing Address - Street 1:PO BOX 291
Mailing Address - Street 2:
Mailing Address - City:SOCIETY HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29593-0291
Mailing Address - Country:US
Mailing Address - Phone:843-250-4436
Mailing Address - Fax:
Practice Address - Street 1:280 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SOCIETY HILL
Practice Address - State:SC
Practice Address - Zip Code:29593
Practice Address - Country:US
Practice Address - Phone:843-250-4436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0663416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport