Provider Demographics
NPI:1700960564
Name:HONEA PATH EMS
Entity Type:Organization
Organization Name:HONEA PATH EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-844-7422
Mailing Address - Street 1:204 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HONEA PATH
Mailing Address - State:SC
Mailing Address - Zip Code:29654-1523
Mailing Address - Country:US
Mailing Address - Phone:864-369-0112
Mailing Address - Fax:
Practice Address - Street 1:6 GAINES RD
Practice Address - Street 2:
Practice Address - City:HONEA PATH
Practice Address - State:SC
Practice Address - Zip Code:29654-1306
Practice Address - Country:US
Practice Address - Phone:864-369-0112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC005341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAB0117Medicaid
SCAB0117Medicaid
SCQ291990001Medicare PIN