Provider Demographics
NPI:1306396585
Name:PALMETTO HEALTH
Entity Type:Organization
Organization Name:PALMETTO HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-434-1842
Mailing Address - Street 1:6 RICHLAND MEDICAL PARK DR
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6864
Mailing Address - Country:US
Mailing Address - Phone:803-434-2762
Mailing Address - Fax:803-434-2713
Practice Address - Street 1:6 RICHLAND MEDICAL PARK DR
Practice Address - Street 2:SUITE 2100
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6864
Practice Address - Country:US
Practice Address - Phone:803-434-2762
Practice Address - Fax:803-434-2713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20438204F00000X, 207RA0001X, 207RA0201X, 207RC0000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
No204F00000XAllopathic & Osteopathic PhysiciansTransplant SurgeryGroup - Single Specialty
No207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant CardiologyGroup - Single Specialty
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Single Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC20000290OtherFIRST CHOICE SELECT UB
SC20000321OtherFIRST CHOICE SELECT 1500
SC400186Medicaid
SC20000321OtherFIRST CHOICE SELECT 1500
SC420018Medicare Oscar/Certification