Provider Demographics
NPI:1396744090
Name:LODGE RESCUE SQUAD
Entity type:Organization
Organization Name:LODGE RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:SR
Authorized Official - Credentials:DIRECTOR/EMT
Authorized Official - Phone:843-866-2322
Mailing Address - Street 1:5005 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-9154
Mailing Address - Country:US
Mailing Address - Phone:803-957-7111
Mailing Address - Fax:803-957-7115
Practice Address - Street 1:395 HIGH COTTON RD
Practice Address - Street 2:
Practice Address - City:LODGE
Practice Address - State:SC
Practice Address - Zip Code:29082-9178
Practice Address - Country:US
Practice Address - Phone:803-957-7111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance