Provider Demographics
NPI:1376890152
Name:PALMETTO TRAVEL MEDICINE
Entity Type:Organization
Organization Name:PALMETTO TRAVEL MEDICINE
Other - Org Name:PASSPORT HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-225-5688
Mailing Address - Street 1:2154 N CENTER ST
Mailing Address - Street 2:SUITE A104
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-4056
Mailing Address - Country:US
Mailing Address - Phone:843-225-5688
Mailing Address - Fax:843-225-5689
Practice Address - Street 1:2154 N CENTER ST
Practice Address - Street 2:SUITE A104
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-4056
Practice Address - Country:US
Practice Address - Phone:843-225-5688
Practice Address - Fax:843-225-5689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD7722261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health