Healthcare Provider Details

I. General information

NPI: 1417211954
Provider Name (Legal Business Name): PALMETTO HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MEDICAL PARK DRIVE
COLUMBIA SC
29203-0000
US

IV. Provider business mailing address

621 CARNEGIE DR SUITE 210
SAN BERNARDINO CA
92408-3536
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-6043
  • Fax: 803-434-4860
Mailing address:
  • Phone: 909-915-2305
  • Fax: 402-952-2443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS B ECKERT
Title or Position: DIRECTOR OF PATIENT ACCOUNTS
Credential:
Phone: 803-296-2548