MEDICARE: PALMETTO HEALTH

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	341600000X	Ambulance	197	SC

General Provider Information

NPI Number	:	1568559797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO HEALTH

Provider Business Mailing Address
First Line	:	PO BOX 402145
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-2145
Country	:	US
Telephone Number	:	803-296-7305
Fax Number	:	803-296-7329

Provider Business Practice Location Address
First Line	:	5 MEDICAL PARK
Second Line	:	PALMETTO HEALTH DBA CHILDRENS HOSPTIAL EMERGENCY TRANS
City	:	COLUMBIA
State	:	SC
Zip	:	29202-9154
Country	:	US
Telephone Number	:	803-434-6043
Fax Number	:	803-434-4860

Authorized Official
Title or Position	:	DIRECTOR BUSINESS DEV.-FINANCE
Name	:	DARRELL C COVEN
Credential	:
Telephone Number	:	803-296-7301

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	10/14/2009

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Directions to “PALMETTO HEALTH ” Practice Location

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