Healthcare Provider Details

I. General information

NPI: 1265462659
Provider Name (Legal Business Name): PALMETTO INFUSION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 SUNSET BLVD
WEST COLUMBIA SC
29169-3425
US

IV. Provider business mailing address

PO BOX 538476
ATLANTA GA
30353-8476
US

V. Phone/Fax

Practice location:
  • Phone: 800-809-1265
  • Fax: 803-772-7782
Mailing address:
  • Phone: 803-227-5447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number11512
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CONNIE C HARTLEY
Title or Position: VICE PRESIDENT REIMBURSEMENT
Credential:
Phone: 803-227-5447