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General NPI Number Information
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NPI Number | 1194308882
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Entity Type | Organization
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Legal Business Name | PALMETTO KIDNEY AND HYPERTENSION ASSOCIATES LLC
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Dates
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Enumeration Date | 04/30/2021
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Last Update Date | 04/30/2021
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Provider Practice Location Address
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Address Line | 2601 LAUREL ST STE 230
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City | COLUMBIA
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State | SC
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Zip | 29204-2034
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Country | US
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Telephone | 803-722-4001
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Fax | 803-205-4008
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Provider Business Mailing Address
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Address Line | 2601 LAUREL ST STE 230
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City | COLUMBIA
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State | SC
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Zip | 29204-2034
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Country | US
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Telephone | 803-722-4001
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Fax | 803-205-4008
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | STEPHEN OSAGUONA
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Credential | MD
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Telephone | 803-722-4001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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