Provider Demographics
NPI:1043273949
Name:PALMETTO HEMATOLOGY ONCOLOGY PC
Entity Type:Organization
Organization Name:PALMETTO HEMATOLOGY ONCOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:BEARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-560-7050
Mailing Address - Street 1:380 SERPENTINE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-3066
Mailing Address - Country:US
Mailing Address - Phone:864-560-7050
Mailing Address - Fax:864-560-0800
Practice Address - Street 1:380 SERPENTINE DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3041
Practice Address - Country:US
Practice Address - Phone:864-560-7050
Practice Address - Fax:864-560-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCD5663OtherRAILROAD MEDICARE
NC790270VOtherNORTH CAROLINA MEDICAID
SCGP1483Medicaid
SCGP1483Medicaid
SC5172Medicare PIN