MEDICARE: PALMETTO PRIMARY CARE PHYSICIANS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	2085R0202X	Diagnostic Radiology Physician
2	2085U0001X	Diagnostic Ultrasound Physician
3	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center
4	261QP2000X	Physical Therapy Clinic/Center
5	261QU0200X	Urgent Care Clinic/Center
6	291U00000X	Clinical Medical Laboratory
7	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CD2393	OTHER	SC	RR MEDICARE

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	:	1629017694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO PRIMARY CARE PHYSICIANS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 530062
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30353-0062
Country	:	US
Telephone Number	:	843-695-6071
Fax Number	:	843-569-5881

Provider Business Practice Location Address
First Line	:	2550 ELMS CENTER RD
Second Line	:
City	:	N CHARLESTON
State	:	SC
Zip	:	29406-9844
Country	:	US
Telephone Number	:	843-572-7727
Fax Number	:	843-569-5872

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THOMAS BRANTLEY ARNAU
Credential	:	MD
Telephone Number	:	843-572-7727

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	06/01/2021

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