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General NPI Number Information
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NPI Number | 1851286645
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Entity Type | Organization
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Legal Business Name | PALMETTO FERTILITY, LLC
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Dates
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Enumeration Date | 06/11/2025
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 700 EXECUTIVE CENTER DR STE 300
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City | GREENVILLE
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State | SC
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Zip | 29615-4555
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Country | US
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Telephone | 864-412-1950
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Fax | 864-412-0640
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Provider Business Mailing Address
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Address Line | 700 EXECUTIVE CENTER DR STE 300
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City | GREENVILLE
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State | SC
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Zip | 29615-4555
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Country | US
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Telephone | 864-412-1950
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Fax | 864-412-0640
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Authorized Official
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Title or Position | CHIEF MANAGED CARE OFFICER
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Name | DIANE JEAN RAVECH
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Credential |
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Telephone | 860-305-6640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number |
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License Number State |
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