Provider Demographics
NPI:1083664395
Name:PALMETTO BONE & JOINT PA
Entity Type:Organization
Organization Name:PALMETTO BONE & JOINT PA
Other - Org Name:PHYSICIANS HEALTH AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:H
Authorized Official - Last Name:MILNER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:864-938-0611
Mailing Address - Street 1:105 PHYSICIANS PARK DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-7551
Mailing Address - Country:US
Mailing Address - Phone:864-938-0111
Mailing Address - Fax:864-938-0811
Practice Address - Street 1:105 PHYSICIANS PARK DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-7551
Practice Address - Country:US
Practice Address - Phone:864-938-0111
Practice Address - Fax:864-938-0811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSL0033Medicaid
SCQ323470001Medicare ID - Type Unspecified