Healthcare Provider Details

I. General information

NPI: 1700547973
Provider Name (Legal Business Name): PALMETTO SOUTHERN COMFORT DIAGNOSTICS (PSC DIAGNOSTICS)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2022
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6941 N TRENHOLM RD STE I
COLUMBIA SC
29206-1730
US

IV. Provider business mailing address

6941 N TRENHOLM RD STE I
COLUMBIA SC
29206-1730
US

V. Phone/Fax

Practice location:
  • Phone: 803-369-2133
  • Fax:
Mailing address:
  • Phone: 803-369-2133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROLANDA L GOODWIN
Title or Position: OWNER
Credential:
Phone: 803-369-2133