Healthcare Provider Details

I. General information

NPI: 1750681078
Provider Name (Legal Business Name): PALMETTO RESPIRATORY,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 11/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

697 HIGHWAY 78
RIDGEVILLE SC
29472-8111
US

IV. Provider business mailing address

697 HIGHWAY 78
RIDGEVILLE SC
29472-8111
US

V. Phone/Fax

Practice location:
  • Phone: 843-826-1943
  • Fax: 843-873-2925
Mailing address:
  • Phone: 843-826-1943
  • Fax: 843-873-2925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279H0200X
TaxonomyHome Health Registered Respiratory Therapist
License NumberRCP 4158
License Number StateSC

VIII. Authorized Official

Name: MRS. APRIL LYNN MERRITT
Title or Position: OWNER
Credential: RRT
Phone: 843-826-1943