Provider Demographics
NPI:1164619326
Name:PALMETTO MEDICAL SUPPLIES, LLC
Entity Type:Organization
Organization Name:PALMETTO MEDICAL SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANAHIT
Authorized Official - Middle Name:
Authorized Official - Last Name:KHACHATRIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-665-1301
Mailing Address - Street 1:1904 ACADEMY ST UNIT C
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6958
Mailing Address - Country:US
Mailing Address - Phone:803-665-1301
Mailing Address - Fax:803-407-0534
Practice Address - Street 1:1904 ACADEMY ST UNIT C
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6958
Practice Address - Country:US
Practice Address - Phone:803-665-1301
Practice Address - Fax:803-407-0534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE3042Medicaid
SC1034789OtherACM
SC1034789OtherACM