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General NPI Number Information
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NPI Number | 1629039102
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Entity Type | Organization
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Legal Business Name | PALMETTO SURGERY LLC
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Dates
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Enumeration Date | 04/01/2006
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Last Update Date | 11/07/2007
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Provider Practice Location Address
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Address Line | 1578 CONSTITUTION BLVD 01
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City | ROCK HILL
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State | SC
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Zip | 29732-3004
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Country | US
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Telephone | 803-324-5858
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Fax | 803-324-5585
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Provider Business Mailing Address
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Address Line | PO BOX 36548
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City | ROCK HILL
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State | SC
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Zip | 29732-0509
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Country | US
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Telephone | 803-324-5858
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Fax | 803-324-5585
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. SHARAREH V BORHANIAN
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Credential | DMD
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Telephone | 803-324-5858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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