MEDICARE: PALMETTO OXYGEN LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	332BC3200X	Customized Equipment (DME)
3	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
4	332BX2000X	Oxygen Equipment & Supplies (DME)

General Provider Information

NPI Number	:	1437781200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO OXYGEN LLC

Provider Business Mailing Address
First Line	:	220 W GERMANTOWN PIKE STE 250
Second Line	:
City	:	PLYMOUTH MEETING
State	:	PA
Zip	:	19462-1437
Country	:	US
Telephone Number	:	646-880-0473
Fax Number	:

Provider Business Practice Location Address
First Line	:	1005 WH SMITH BLVD
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-5052
Country	:	US
Telephone Number	:	252-353-6800
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LUKE MCGEE
Credential	:
Telephone Number	:	646-880-0473

Provider Enumeration Date	:	02/10/2020
Last Update Date	:	04/14/2020

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Directions to “PALMETTO OXYGEN LLC ” Practice Location

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