MEDICARE: PALMETTO HOSPITALIST SERVICES 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	24782	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	24782	OTHER	SC	INDIVIDUAL NPI 1932170305

General Provider Information

NPI Number	:	1245651819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO HOSPITALIST SERVICES LLC

Provider Business Mailing Address
First Line	:	PO BOX 1733
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29071-1733
Country	:	US
Telephone Number	:	803-359-7527
Fax Number	:

Provider Business Practice Location Address
First Line	:	2131 WOODRUFF RD STE 2100
Second Line	:	#269
City	:	GREENVILLE
State	:	SC
Zip	:	29607-5959
Country	:	US
Telephone Number	:	248-303-0257
Fax Number	:

Authorized Official
Title or Position	:	BILLING DEPARTMENT
Name	:	MARTY RAE ANDERSON
Credential	:
Telephone Number	:	803-359-7527

Provider Enumeration Date	:	12/26/2013
Last Update Date	:	12/26/2013

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