Healthcare Provider Details

I. General information

NPI: 1376592204
Provider Name (Legal Business Name): PALMETTO ENDOSCOPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 09/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2073 CHARLIE HALL BLVD
CHARLESTON SC
29414-5834
US

IV. Provider business mailing address

2073 CHARLIE HALL BLVD
CHARLESTON SC
29414-5834
US

V. Phone/Fax

Practice location:
  • Phone: 843-571-0643
  • Fax: 843-377-0499
Mailing address:
  • Phone: 843-571-0643
  • Fax: 843-377-0499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberASF084
License Number StateSC

VIII. Authorized Official

Name: SABRINA MCCLEAF
Title or Position: HR
Credential:
Phone: 843-571-0673