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General NPI Number Information
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NPI Number | 1558442079
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Entity Type | Organization
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Legal Business Name | PALMETTO HEALTH
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 09/24/2012
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Provider Practice Location Address
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Address Line | 14 RICHLAND MEDICAL PARK DRIVE SUITE310
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City | COULMBIA
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State | SC
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Zip | 29203
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Country | US
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Telephone | 803-296-2548
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Fax | 803-296-2548
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Provider Business Mailing Address
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Address Line | PO BOX 402145 PALMETTO HEALTH
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City | ATLANTA
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State | GA
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Zip | 30384-2145
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Country | US
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Telephone | 803-296-2548
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Fax | 803-296-3040
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Authorized Official
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Title or Position | DIRECTOR OF PFS
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Name | THOMAS B ECKERT
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Credential |
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Telephone | 803-296-2548
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State | SC
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