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General NPI Number Information
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NPI Number | 1184669376
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Entity Type | Organization
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Legal Business Name | PALMETTO UROLOGICAL PA
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11 PARK CREEK DR
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City | GREENVILLE
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State | SC
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Zip | 29605-4270
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Country | US
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Telephone | 864-242-1220
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Fax |
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Provider Business Mailing Address
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Address Line | 11 PARK CREEK DR
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City | GREENVILLE
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State | SC
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Zip | 29605-4270
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Country | US
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Telephone | 864-242-1220
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. JENNIFER L MITCHELL
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Credential |
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Telephone | 864-244-1220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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