Provider Demographics
NPI:1104818152
Name:CAPITAL CITY AMBULANCE INC
Entity type:Organization
Organization Name:CAPITAL CITY AMBULANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-442-7555
Mailing Address - Street 1:PO BOX 6365
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29861-6365
Mailing Address - Country:US
Mailing Address - Phone:803-442-7555
Mailing Address - Fax:803-279-1275
Practice Address - Street 1:106 NEW DELAUGHTER DR
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29860-8471
Practice Address - Country:US
Practice Address - Phone:803-442-7555
Practice Address - Fax:803-279-1275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC215 541190608903341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAB0220Medicaid
SCP00103431Medicare PIN