Provider Demographics
NPI:1366488116
Name:PALMETTO ADULT MEDICINE LLC
Entity Type:Organization
Organization Name:PALMETTO ADULT MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:E
Authorized Official - Last Name:POSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-905-6800
Mailing Address - Street 1:1295 WILSON HALL RD
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-1804
Mailing Address - Country:US
Mailing Address - Phone:803-905-6800
Mailing Address - Fax:803-905-6810
Practice Address - Street 1:1295 WILSON HALL RD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1804
Practice Address - Country:US
Practice Address - Phone:803-905-6800
Practice Address - Fax:803-905-6810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2526Medicaid