MEDICARE: PALMETTO INFECTIOUS DISEASE PHYSICIANS

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	207RI0200X	Infectious Disease Physician	19747	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255397840
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO INFECTIOUS DISEASE PHYSICIANS

Provider Business Mailing Address
First Line	:	2850 JACKSON DR
Second Line	:
City	:	ORANGEBURG
State	:	SC
Zip	:	29118-3156
Country	:	US
Telephone Number	:	803-539-0505
Fax Number	:	803-539-0410

Provider Business Practice Location Address
First Line	:	1097B COOK RD
Second Line	:
City	:	ORANGEBURG
State	:	SC
Zip	:	29118-8209
Country	:	US
Telephone Number	:	803-539-0505
Fax Number	:	803-539-0410

Authorized Official
Title or Position	:	DOCTOR
Name	:	MR. JOHN HUNTER SAMIES
Credential	:	M.D.
Telephone Number	:	803-539-0505

Provider Enumeration Date	:	04/24/2006
Last Update Date	:	03/09/2021

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