Organization
LAKESIDE MEDICAL RESPONSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHAMEEKA S MCDUFFIE (OWNER)
(843) 260-0922
Entity
Organization
Contact information
Practice address
770 S RON MCNAIR BLVD, UNIT A, LAKE CITY, SC 29560-3824
(843) 374-7480
Mailing address
770 S RON MCNAIR BLVD, UNIT A, LAKE CITY, SC 29560-3824
(843) 374-7480
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
234
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
234
DHEC
SC
05
—
AB0255
—
SC
Enumeration date
04/24/2007
Last updated
08/22/2020
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