Healthcare Provider Details

I. General information

NPI: 1750767950
Provider Name (Legal Business Name): PALMETTO HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 09/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 SALUDA POINTE DR
LEXINGTON SC
29072-7295
US

IV. Provider business mailing address

PO BOX 848932
BOSTON MA
02284-8932
US

V. Phone/Fax

Practice location:
  • Phone: 803-296-9200
  • Fax: 803-296-9697
Mailing address:
  • Phone: 803-296-7303
  • Fax: 803-296-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateSC

VIII. Authorized Official

Name: MR. DARRELL C COVEN
Title or Position: DIRECTOR, BUS FINANCE
Credential:
Phone: 803-296-7301