Provider Demographics
NPI:1083683288
Name:PALMETTO TRI-COUNTY INTERNAL MEDICINE, PA
Entity Type:Organization
Organization Name:PALMETTO TRI-COUNTY INTERNAL MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:G
Authorized Official - Last Name:SISTARE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:803-286-4705
Mailing Address - Street 1:201 W MEETING ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-2380
Mailing Address - Country:US
Mailing Address - Phone:803-286-4666
Mailing Address - Fax:803-283-1951
Practice Address - Street 1:201 W MEETING ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-2380
Practice Address - Country:US
Practice Address - Phone:803-286-4666
Practice Address - Fax:803-283-1951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5986Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER