Healthcare Provider Details

I. General information

NPI: 1891147062
Provider Name (Legal Business Name): PALMETTO HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 07/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 RICHLAND MEDICAL PARK DR SUITE 7200
COLUMBIA SC
29203-6863
US

IV. Provider business mailing address

PO BOX 402145
ATLANTA GA
30384-2145
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-2325
  • Fax: 803-434-7379
Mailing address:
  • Phone: 803-296-7303
  • Fax: 803-296-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DARRELL COVEN
Title or Position: DIRECTOR, AMBULATORY SERVICES FINAN
Credential:
Phone: 803-296-7301