MEDICARE: PALMETTO EAR NOSE THROAT 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	207Y00000X	Otolaryngology Physician

General Provider Information

NPI Number	:	1437363843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO EAR NOSE THROAT PA

Provider Business Mailing Address
First Line	:	4101 MAIN ST
Second Line	:	PROFESSIONAL PLAZA UNIT F
City	:	HILTON HEAD
State	:	SC
Zip	:	29926-4608
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4101 MAIN ST
Second Line	:	PROFESSIONAL PLAZA UNIT F
City	:	HILTON HEAD
State	:	SC
Zip	:	29926-4608
Country	:	US
Telephone Number	:	843-681-2300
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTINA GWOZDZ
Credential	:
Telephone Number	:	843-681-2300

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	11/29/2007

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