Provider Demographics
NPI:1154403020
Name:PELZER RESCUE SQUAD
Entity type:Organization
Organization Name:PELZER RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:A/R SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:E
Authorized Official - Last Name:HEATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-261-8859
Mailing Address - Street 1:PO BOX 1934
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29622-1934
Mailing Address - Country:US
Mailing Address - Phone:864-261-8859
Mailing Address - Fax:
Practice Address - Street 1:141 LEBBY ST
Practice Address - Street 2:
Practice Address - City:PELZER
Practice Address - State:SC
Practice Address - Zip Code:29669-1721
Practice Address - Country:US
Practice Address - Phone:864-261-8859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC004341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAB0108Medicaid