County of Dillon

Primary specialty

AmbulanceTaxonomy code 341600000X

License

082 Issued in SC

Legal business name

COUNTY OF DILLON

Practice address

1415 E Main St
Dillon, SC 29536-3745

Phone

(843) 774-1441

NPI assigned

May 4, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Randy Grimsley

Title

EMS Director

Phone

(843) 845-1344

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• DILLON COUNTY AMB SERVICE Other name

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403827200000",
    "number": "1124076385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 SOUTH 3RD AVE",
            "city": "DILLON",
            "state": "SC",
            "postal_code": "295369154",
            "telephone_number": "803-957-7111",
            "fax_number": "803-957-7115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 E MAIN ST",
            "city": "DILLON",
            "state": "SC",
            "postal_code": "295363745",
            "telephone_number": "843-774-1441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF DILLON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-04",
        "last_updated": "2014-06-27",
        "status": "A",
        "authorized_official_last_name": "GRIMSLEY",
        "authorized_official_first_name": "RANDY",
        "authorized_official_title_or_position": "EMS DIRECTOR",
        "authorized_official_telephone_number": "843-845-1344"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "SC",
            "license": "082",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "501905",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMB MEDICARE TRAVELERS",
            "identifier": "590026748",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DILLON COUNTY AMB SERVICE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• All providers in Dillon, SC
• Ambulance in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.