Provider Demographics
NPI:1124076385
Name:COUNTY OF DILLON
Entity type:Organization
Organization Name:COUNTY OF DILLON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIMSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-845-1344
Mailing Address - Street 1:109 SOUTH 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536-9154
Mailing Address - Country:US
Mailing Address - Phone:803-957-7111
Mailing Address - Fax:803-957-7115
Practice Address - Street 1:1415 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-3745
Practice Address - Country:US
Practice Address - Phone:843-774-1441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC082341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC501905Medicaid
SC590026748OtherAMB MEDICARE TRAVELERS
SCQ258170001Medicare PIN