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	2080P0207X	Pediatric Hematology & Oncology Physician

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

General Provider Information

NPI Number	:	1831128586
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	:	803-296-7306
Fax Number	:	803-296-7329

Provider Business Practice Location Address
First Line	:	7 RICHLAND MEDICAL PARK DR
Second Line	:	SUITE 203
City	:	COLUMBIA
State	:	SC
Zip	:	29203-6863
Country	:	US
Telephone Number	:	803-434-3533
Fax Number	:	803-434-3094

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

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	11/21/2012

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Directions to “PALMETTO HEALTH ” Practice Location

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