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Organization
WACCAMAW MEDICAL TRANSPORT, INC.
Active
Organization
WACCAMAW MEDICAL TRANSPORT, INC.
Active
Other names
Lifestar
Organization subpart
No
Provider details
NPI number
Authorized official
DEDIE J. GARREN (DIRECTOR OF FINANCE)
(843) 997-1535
Entity
Organization
Contact information
Practice address
3926 WESLEY ST, SUITE 202, MYRTLE BEACH, SC 29579-7332
(843) 903-5290
(843) 903-4980
Mailing address
3926 WESLEY ST, SUITE 202, MYRTLE BEACH, SC 29579-7332
(843) 903-5290
(843) 903-4980
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
109
SC
341600000X
Ambulance
1616
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AB0206
—
SC
Enumeration date
10/22/2005
Last updated
08/22/2020
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