Healthcare Provider Details

I. General information

NPI: 1588016687
Provider Name (Legal Business Name): PALMETTO INFUSION SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 07/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9295 MEDICAL PLAZA DR SUITE C
NORTH CHARLESTON SC
29406-9137
US

IV. Provider business mailing address

PO BOX 538476
ATLANTA GA
30353-8476
US

V. Phone/Fax

Practice location:
  • Phone: 843-414-0287
  • Fax: 866-872-8920
Mailing address:
  • Phone: 800-809-1265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number16714
License Number StateSC

VIII. Authorized Official

Name: CONNIE HARTLEY
Title or Position: CHIEF REIMBURSEMENT OFFICER
Credential:
Phone: 803-277-5447