Medic of South Carolina, LLC

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

Legal business name

MEDIC OF SOUTH CAROLINA, LLC

Practice address

604 E Broad St
Darlington, SC 29532

Phone

(843) 968-9118

Fax

(843) 878-9836

NPI assigned

Oct 22, 2016

Organization subpart

No

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

Authorized official

Name

Charles Allen Tisdale

Title

President

Phone

(843) 968-9118

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1477094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660608000000",
    "number": "1700337987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1335",
            "city": "HARTSVILLE",
            "state": "SC",
            "postal_code": "295511335",
            "telephone_number": "843-968-9118",
            "fax_number": "843-878-9836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 E BROAD ST",
            "city": "DARLINGTON",
            "state": "SC",
            "postal_code": "29532",
            "telephone_number": "843-968-9118",
            "fax_number": "843-878-9836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDIC OF SOUTH CAROLINA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-22",
        "last_updated": "2022-08-16",
        "certification_date": "2022-08-09",
        "status": "A",
        "authorized_official_last_name": "TISDALE",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "843-968-9118"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SC DHEC",
            "identifier": "382",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "AB0372",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.