Provider Demographics
NPI:1396178547
Name:PALMETTO GERIATRICS, LLC
Entity Type:Organization
Organization Name:PALMETTO GERIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCHUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-758-4043
Mailing Address - Street 1:107 S FRANKLIN DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4364
Mailing Address - Country:US
Mailing Address - Phone:843-758-4043
Mailing Address - Fax:888-557-1131
Practice Address - Street 1:107 S FRANKLIN DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4364
Practice Address - Country:US
Practice Address - Phone:843-758-4043
Practice Address - Fax:888-557-1131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-12
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty