Provider Demographics
NPI:1770745358
Name:MYRTLE BEACH AIR, LLC
Entity type:Organization
Organization Name:MYRTLE BEACH AIR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:RICKY
Authorized Official - Last Name:GUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-446-9263
Mailing Address - Street 1:1860 GRAY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-7425
Mailing Address - Country:US
Mailing Address - Phone:843-446-9263
Mailing Address - Fax:843-399-7888
Practice Address - Street 1:1860 GRAY OAKS DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-7425
Practice Address - Country:US
Practice Address - Phone:843-446-9263
Practice Address - Fax:843-399-7888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2453416A0800X
SC2543416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No3416A0800XTransportation ServicesAmbulanceAir Transport