MEDICARE: PALMETTO DIAGNOSTICS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center
2	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1114318813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO DIAGNOSTICS, LLC

Provider Business Mailing Address
First Line	:	1060 CHRIS CIR
Second Line	:	SUITE D
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29169-4773
Country	:	US
Telephone Number	:	803-217-0105
Fax Number	:	803-796-7846

Provider Business Practice Location Address
First Line	:	642 SUNSET BLVD
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29169-7346
Country	:	US
Telephone Number	:	803-217-0105
Fax Number	:	35-267-3498

Authorized Official
Title or Position	:	OWNER
Name	:	JASON CATONE
Credential	:
Telephone Number	:	803-767-3985

Provider Enumeration Date	:	02/17/2015
Last Update Date	:	08/24/2023

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