1457688236 NPI number — SAINT MATTHEWS AMBULANCE SERVICE LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457688236 NPI number — SAINT MATTHEWS AMBULANCE SERVICE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAINT MATTHEWS AMBULANCE SERVICE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457688236
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 738
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALTERBORO
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29488
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-826-6862
Provider Business Mailing Address Fax Number:
803-826-6862

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39 TECKLENBURG LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST MATTHEWS
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-957-7111
Provider Business Practice Location Address Fax Number:
803-957-7115
Provider Enumeration Date:
11/16/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BALL
Authorized Official First Name:
JUDY
Authorized Official Middle Name:
ANNE
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
803-378-7940

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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