Provider Demographics
NPI:1437185626
Name:PALMETTO HOME MEDICAL
Entity Type:Organization
Organization Name:PALMETTO HOME MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:VIGGIANO
Authorized Official - Last Name:DENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-796-7840
Mailing Address - Street 1:138 BROOKSIDE PKWY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-4234
Mailing Address - Country:US
Mailing Address - Phone:803-429-9310
Mailing Address - Fax:
Practice Address - Street 1:138 BROOKSIDE PKWY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-4234
Practice Address - Country:US
Practice Address - Phone:803-796-7840
Practice Address - Fax:803-796-7846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC032345445332B00000X
332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2013Medicaid
SCDE2013Medicaid