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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