Provider Demographics
NPI:1033153051
Name:PALMETTO DISABLILITY EVALUATIONS, INC.
Entity Type:Organization
Organization Name:PALMETTO DISABLILITY EVALUATIONS, INC.
Other - Org Name:CHARLES B THOMAS JR., MD ORTHOPAEDIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:U
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-560-4475
Mailing Address - Street 1:535 W BUTLER RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-4833
Mailing Address - Country:US
Mailing Address - Phone:864-277-9867
Mailing Address - Fax:864-299-3442
Practice Address - Street 1:535 WEST BUTLER RD
Practice Address - Street 2:SUITE C
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662
Practice Address - Country:US
Practice Address - Phone:864-277-9867
Practice Address - Fax:864-299-3442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC12306174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC123066Medicaid
SCDD8975OtherRR MEDICARE
SC123066Medicaid
SC8129Medicare PIN