Provider Demographics
NPI:1902909864
Name:SURFSIDE BEACH RESCUE SQUAD
Entity Type:Organization
Organization Name:SURFSIDE BEACH RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:NREMT-B
Authorized Official - Phone:843-357-8334
Mailing Address - Street 1:P.O. BOX 14011
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29578-4011
Mailing Address - Country:US
Mailing Address - Phone:843-238-1216
Mailing Address - Fax:
Practice Address - Street 1:829 PINE DR
Practice Address - Street 2:
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29578-4011
Practice Address - Country:US
Practice Address - Phone:843-238-1216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC112341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance