Provider Demographics
NPI:1548253784
Name:FORT MILL RESCUE SQUAD
Entity type:Organization
Organization Name:FORT MILL RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MCMICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:NREMT-P
Authorized Official - Phone:803-548-1456
Mailing Address - Street 1:PO BOX 1011
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29716-1011
Mailing Address - Country:US
Mailing Address - Phone:803-548-1456
Mailing Address - Fax:
Practice Address - Street 1:216 S WHITE ST
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-2154
Practice Address - Country:US
Practice Address - Phone:803-957-7111
Practice Address - Fax:803-957-7115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC078341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance