MEDICARE: PALMETTO MEDICAL CLINIC 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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1124611520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO MEDICAL CLINIC LLC

Provider Business Mailing Address
First Line	:	5126 MORNING FROST PL
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-3576
Country	:	US
Telephone Number	:	843-220-0551
Fax Number	:

Provider Business Practice Location Address
First Line	:	5126 MORNING FROST PL
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-3576
Country	:	US
Telephone Number	:	843-220-0551
Fax Number	:

Authorized Official
Title or Position	:	FAMILY NURSE PRACTITIONER
Name	:	EMILY NEAL DELEON
Credential	:	APRN
Telephone Number	:	843-220-0551

Provider Enumeration Date	:	02/16/2021
Last Update Date	:	01/27/2025

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