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General NPI Number Information
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NPI Number | 1114128824
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Entity Type | Organization
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Legal Business Name | HEALTHWORKS OF PALMETTO BAPTIST
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 09/10/2008
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Provider Practice Location Address
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Address Line | 1333 TAYLOR ST SUITE 3-H
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City | COLUMBIA
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State | SC
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Zip | 29220-0001
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Country | US
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Telephone | 803-296-3304
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Fax |
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Provider Business Mailing Address
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Address Line | 1333 TAYLOR ST SUITE 3-H
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City | COLUMBIA
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State | SC
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Zip | 29220-0001
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Country | US
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Telephone | 803-296-3304
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JACQUELYN FLETCHER VAN DAM
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Credential | M.D.
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Telephone | 803-296-3304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 22508
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License Number State | SC
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