Provider Demographics
NPI:1114128824
Name:HEALTHWORKS OF PALMETTO BAPTIST
Entity Type:Organization
Organization Name:HEALTHWORKS OF PALMETTO BAPTIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:FLETCHER
Authorized Official - Last Name:VAN DAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-296-3304
Mailing Address - Street 1:1333 TAYLOR ST
Mailing Address - Street 2:SUITE 3-H
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29220-0001
Mailing Address - Country:US
Mailing Address - Phone:803-296-3304
Mailing Address - Fax:
Practice Address - Street 1:1333 TAYLOR ST
Practice Address - Street 2:SUITE 3-H
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29220-0001
Practice Address - Country:US
Practice Address - Phone:803-296-3304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22508282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital