Provider Demographics
NPI:1154742856
Name:SOCIETY HILL RESCUE SQUAD
Entity type:Organization
Organization Name:SOCIETY HILL RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JORDAN
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-858-0634
Mailing Address - Street 1:PO BOX 291
Mailing Address - Street 2:
Mailing Address - City:SOCIETY HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29593-0291
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:280 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:SOCIETY HILL
Practice Address - State:SC
Practice Address - Zip Code:29593
Practice Address - Country:US
Practice Address - Phone:843-378-4660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC066341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance