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General NPI Number Information
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NPI Number | 1881604114
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Entity Type | Organization
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Legal Business Name | PALMETTO ORTHOPAEDIC AND SPORTS MEDICINE CENTER, LLC
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 05/01/2018
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Provider Practice Location Address
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Address Line | 595 W WESMARK BLVD
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City | SUMTER
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State | SC
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Zip | 29150-1969
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Country | US
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Telephone | 803-469-4028
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Fax | 803-469-2663
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Provider Business Mailing Address
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Address Line | 595 W WESMARK BLVD
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City | SUMTER
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State | SC
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Zip | 29150-1969
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Country | US
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Telephone | 803-469-4028
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Fax | 803-469-2663
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Authorized Official
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Title or Position | OFFICE MANGER
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Name | KAROLINE K KIRVEN
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Credential | DO
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Telephone | 803-469-4028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number | 4919
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License Number State | SC
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