Provider Demographics
NPI:1437135761
Name:PALMETTO INTERNAL MEDICINE OF SUMMERVILLE PC
Entity Type:Organization
Organization Name:PALMETTO INTERNAL MEDICINE OF SUMMERVILLE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COLBY
Authorized Official - Middle Name:H
Authorized Official - Last Name:GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-851-2000
Mailing Address - Street 1:201 OAKBROOK LN
Mailing Address - Street 2:SUITE 255
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8215
Mailing Address - Country:US
Mailing Address - Phone:843-851-2000
Mailing Address - Fax:843-851-2003
Practice Address - Street 1:201 OAKBROOK LN
Practice Address - Street 2:SUITE 255
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8215
Practice Address - Country:US
Practice Address - Phone:843-851-2000
Practice Address - Fax:843-851-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1087230001Medicare NSC