MEDICARE: PALMETTO PATHOLOGY PA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207ZB0001X	Blood Banking & Transfusion Medicine Physician
2	207ZC0500X	Cytopathology Physician
3	207ZD0900X	Dermatopathology (Pathology) Physician
4	207ZF0201X	Forensic Pathology Physician
5	207ZH0000X	Hematology (Pathology) Physician
6	207ZI0100X	Immunopathology Physician
7	207ZM0300X	Medical Microbiology Physician
8	207ZN0500X	Neuropathology Physician
9	207ZP0007X	Molecular Genetic Pathology (Pathology) Physician
10	207ZP0101X	Anatomic Pathology Physician
11	207ZP0104X	Chemical Pathology Physician
12	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician
13	207ZP0213X	Pediatric Pathology Physician
14	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538139795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO PATHOLOGY PA

Provider Business Mailing Address
First Line	:	PO BOX 60070
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29419-0070
Country	:	US
Telephone Number	:	843-716-7000
Fax Number	:	843-716-7272

Provider Business Practice Location Address
First Line	:	3655 MITCHELL ST
Second Line	:	DEPARTMENT OF PATHOLOGY
City	:	LORIS
State	:	SC
Zip	:	29569-2827
Country	:	US
Telephone Number	:	843-716-7000
Fax Number	:	843-716-7272

Authorized Official
Title or Position	:	PRESIDENT PALMETTO PATHOLOGY PA
Name	:	ALEXANDER C LOGAN III
Credential	:	MD
Telephone Number	:	843-716-7000

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	08/14/2008

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1831172493 — RAYMOND CRAIG COLLINS M.D.
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1073596631 — RAMIRO JAY GODINES M.D.
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1972587012 — FREDERICK WILLIAM BELLAMY M.D.
Practice Location Address:

3655 MITCHELL ST
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29569-2827

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1780663815 — SUSAN M STUBER MD
Practice Location Address:

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1063492197 — ALEXANDER C LOGAN III MD
Practice Location Address:

3655 MITCHELL ST , DEPARTMENT OF PATHOLOGY
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29569-2827

Practice Phone: 843-716-7000
Practice Fax: 843-716-7272

Directions to “PALMETTO PATHOLOGY PA ” Practice Location

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