Healthcare Provider Details

I. General information

NPI: 1831128586
Provider Name (Legal Business Name): PALMETTO HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 11/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 RICHLAND MEDICAL PARK DR SUITE 203
COLUMBIA SC
29203-6863
US

IV. Provider business mailing address

PO BOX 402145
ATLANTA GA
30384-2145
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-3533
  • Fax: 803-434-3094
Mailing address:
  • Phone: 803-296-7306
  • Fax: 803-296-7329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DARRELL C COVEN
Title or Position: DIRECTOR - BUSINESS DEV/FINANCE
Credential:
Phone: 803-296-7301