Healthcare Provider Details

I. General information

NPI: 1366681827
Provider Name (Legal Business Name): PALMETTO HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2009
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 SAINT JULIAN PLACE
COLUMBIA SC
29204-2410
US

IV. Provider business mailing address

PO BOX 402145
ATLANTA GA
30384-2145
US

V. Phone/Fax

Practice location:
  • Phone: 803-779-2005
  • Fax: 803-765-0007
Mailing address:
  • Phone: 803-296-7305
  • Fax: 803-296-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DARRELL C COVEN
Title or Position: DIRECTOR, AMBULATORY SVCS - FINANCE
Credential:
Phone: 803-296-7301