Provider Demographics
NPI:1295381291
Name:PALMETTO BONE AND JOINT
Entity Type:Organization
Organization Name:PALMETTO BONE AND JOINT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:H
Authorized Official - Last Name:MALNER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:864-833-3046
Mailing Address - Street 1:104 ELLETT ROAD
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036
Mailing Address - Country:US
Mailing Address - Phone:803-941-8096
Mailing Address - Fax:803-345-6088
Practice Address - Street 1:104 ELLETT ROAD
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036
Practice Address - Country:US
Practice Address - Phone:803-941-8096
Practice Address - Fax:803-345-6088
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PALMETTO BONE AND JOINT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0620Medicaid