Provider Demographics
NPI:1154814630
Name:PALMETTO INFUSION SERVICES, LLC
Entity Type:Organization
Organization Name:PALMETTO INFUSION SERVICES, LLC
Other - Org Name:PALMETTO INFUSION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF REIMBURSEMENT OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-277-5447
Mailing Address - Street 1:PO BOX 538476
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-8476
Mailing Address - Country:US
Mailing Address - Phone:800-809-1265
Mailing Address - Fax:
Practice Address - Street 1:217 DOZIER BLVD STE 102
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4090
Practice Address - Country:US
Practice Address - Phone:800-809-1265
Practice Address - Fax:866-872-8920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-11
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2178061OtherPK