Healthcare Provider Details

I. General information

NPI: 1659736619
Provider Name (Legal Business Name): PALMETTO OXYGEN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2015
Last Update Date: 12/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6651 CHIPPEWA ST SUITE 308
SAINT LOUIS MO
63109-2538
US

IV. Provider business mailing address

430 WOODRUFF RD SUITE 450
GREENVILLE SC
29607-3495
US

V. Phone/Fax

Practice location:
  • Phone: 314-371-8519
  • Fax: 877-404-4713
Mailing address:
  • Phone: 864-272-1840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. MATTHEW S MELLOTT
Title or Position: PRESIDENT
Credential:
Phone: 864-272-1840