Healthcare Provider Details

I. General information

NPI: 1588712103
Provider Name (Legal Business Name): PALMETTO ANESTHESIA SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5039 BARRIER ISLAND CT
MT PLEASANT SC
29466-6933
US

IV. Provider business mailing address

9263 MEDICAL PLAZA DR STE E
CHARLESTON SC
29406-7112
US

V. Phone/Fax

Practice location:
  • Phone: 843-881-0403
  • Fax: 843-553-2223
Mailing address:
  • Phone: 843-553-7070
  • Fax: 843-553-2223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN M PRATT
Title or Position: PARTNER
Credential: MD
Phone: 843-553-7070