Healthcare Provider Details

I. General information

NPI: 1114299575
Provider Name (Legal Business Name): PALMETTO HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2012
Last Update Date: 04/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2739 LAUREL ST SUITE 1-A
COLUMBIA SC
29204-2028
US

IV. Provider business mailing address

PO BOX 402145
ATLANTA GA
30384-2145
US

V. Phone/Fax

Practice location:
  • Phone: 803-799-4800
  • Fax: 803-256-0397
Mailing address:
  • Phone: 803-296-7305
  • Fax: 803-296-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DARRELL C. COVEN
Title or Position: DIRECTOR-AMBULATORY SERVICES-FINANC
Credential:
Phone: 803-296-7301