Provider Demographics
NPI:1396191060
Name:PALMETTO AREA HEALTHCARE
Entity Type:Organization
Organization Name:PALMETTO AREA HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:K
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-840-9360
Mailing Address - Street 1:900 GREENVILLE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:WILLIAMSTON
Mailing Address - State:SC
Mailing Address - Zip Code:29697-1130
Mailing Address - Country:US
Mailing Address - Phone:864-840-9360
Mailing Address - Fax:864-847-5706
Practice Address - Street 1:900 GREENVILLE DR
Practice Address - Street 2:SUITE B
Practice Address - City:WILLIAMSTON
Practice Address - State:SC
Practice Address - Zip Code:29697-1130
Practice Address - Country:US
Practice Address - Phone:864-840-9360
Practice Address - Fax:864-847-5706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC1600111N00000X
SCSC19015208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty