MEDICARE: PALMETTO MEDICAL CARE 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	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1194033381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO MEDICAL CARE LLC

Provider Business Mailing Address
First Line	:	1002 S MAIN ST
Second Line	:
City	:	MULLINS
State	:	SC
Zip	:	29574-3920
Country	:	US
Telephone Number	:	843-245-0613
Fax Number	:

Provider Business Practice Location Address
First Line	:	1002 S MAIN ST
Second Line	:
City	:	MULLINS
State	:	SC
Zip	:	29574-3920
Country	:	US
Telephone Number	:	843-245-0613
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. KATHY THOMPKINS
Credential	:	NURSE PRACTIONER
Telephone Number	:	843-245-0613

Provider Enumeration Date	:	09/22/2010
Last Update Date	:	09/22/2010

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