Provider Demographics
NPI:1376055038
Name:PALMETTO EXPRESS CLINIC, LLC
Entity Type:Organization
Organization Name:PALMETTO EXPRESS CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN HEYDE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:843-750-0324
Mailing Address - Street 1:11871 PLAZA DRIVE
Mailing Address - Street 2:UNIT 3
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576
Mailing Address - Country:US
Mailing Address - Phone:843-750-0324
Mailing Address - Fax:855-798-0107
Practice Address - Street 1:11871 PLAZA DRIVE
Practice Address - Street 2:UNIT 3
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576
Practice Address - Country:US
Practice Address - Phone:843-750-0324
Practice Address - Fax:855-798-0107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-02
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty