MEDICARE: PALMETTO HOSPITALIST SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1346662624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO HOSPITALIST SERVICES LLC

Provider Business Mailing Address
First Line	:	PO BOX 1733
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29071-1733
Country	:	US
Telephone Number	:	803-359-7527
Fax Number	:	803-359-6265

Provider Business Practice Location Address
First Line	:	2131 WOODRUFF RD
Second Line	:	SUITE 2100 #269
City	:	GREENVILLE
State	:	SC
Zip	:	29607-5950
Country	:	US
Telephone Number	:	248-303-0257
Fax Number	:	877-348-8216

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KENYA HANSPARD
Credential	:	MD
Telephone Number	:	248-303-0257

Provider Enumeration Date	:	01/06/2014
Last Update Date	:	01/06/2014

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