Provider Demographics
NPI:1366471104
Name:PALMETTO WOMEN'S HEALTHCARE PA
Entity Type:Organization
Organization Name:PALMETTO WOMEN'S HEALTHCARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RIDGEWAY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:803-433-0797
Mailing Address - Street 1:21 E HOSPITAL ST
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-3152
Mailing Address - Country:US
Mailing Address - Phone:803-433-0797
Mailing Address - Fax:
Practice Address - Street 1:21 E HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-3152
Practice Address - Country:US
Practice Address - Phone:803-433-0797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2388Medicaid
SC6257Medicare PIN