MEDICARE: PALMETTO ANESTHESIA SPECIALISTS 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	207L00000X	Anesthesiology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DG4590	OTHER	SC	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1588712103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO ANESTHESIA SPECIALISTS LLC

Provider Business Mailing Address
First Line	:	9263 MEDICAL PLAZA DR
Second Line	:	STE E
City	:	CHARLESTON
State	:	SC
Zip	:	29406-7112
Country	:	US
Telephone Number	:	843-553-7070
Fax Number	:	843-553-2223

Provider Business Practice Location Address
First Line	:	5039 BARRIER ISLAND CT
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29466-6933
Country	:	US
Telephone Number	:	843-881-0403
Fax Number	:	843-553-2223

Authorized Official
Title or Position	:	PARTNER
Name	:	JOHN M PRATT
Credential	:	MD
Telephone Number	:	843-553-7070

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/20/2012

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