Provider Demographics
NPI:1083696991
Name:PALMETTO MEDICAL PRODUCTS
Entity Type:Organization
Organization Name:PALMETTO MEDICAL PRODUCTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-794-4460
Mailing Address - Street 1:PO BOX 85132
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-0023
Mailing Address - Country:US
Mailing Address - Phone:803-794-4460
Mailing Address - Fax:803-794-4669
Practice Address - Street 1:125 WADE ST
Practice Address - Street 2:SUITE B
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4635
Practice Address - Country:US
Practice Address - Phone:803-794-4460
Practice Address - Fax:803-794-4669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE1969Medicaid
4337350001Medicare NSC