MEDICARE: PALMETTO CARDIOLOGY ASSOCIATES, PA

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	174400000X	Specialist

General Provider Information

NPI Number	:	1114976008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO CARDIOLOGY ASSOCIATES, PA

Provider Business Mailing Address
First Line	:	1655 BERNARDIN AVE
Second Line	:	SUITE 300
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2039
Country	:	US
Telephone Number	:	803-252-6644
Fax Number	:	803-365-0606

Provider Business Practice Location Address
First Line	:	1655 BERNARDIN AVE
Second Line	:	SUITE 300
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2039
Country	:	US
Telephone Number	:	803-252-6644
Fax Number	:	803-365-0606

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	ROSLYN JEFFCOAT BUSH
Credential	:
Telephone Number	:	803-252-6644

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	04/20/2008

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