Provider Demographics
NPI:1285088971
Name:ALLIANCE AMBULANCE SERVICE LLC
Entity type:Organization
Organization Name:ALLIANCE AMBULANCE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:T
Authorized Official - Last Name:PROPHETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-556-5766
Mailing Address - Street 1:3120 N BELTLINE BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2774
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3120 N BELTLINE BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2774
Practice Address - Country:US
Practice Address - Phone:803-556-5766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport