Provider Demographics
NPI:1437363843
Name:PALMETTO EAR NOSE THROAT PA
Entity Type:Organization
Organization Name:PALMETTO EAR NOSE THROAT PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GWOZDZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-681-2300
Mailing Address - Street 1:4101 MAIN ST
Mailing Address - Street 2:PROFESSIONAL PLAZA UNIT F
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29926-4608
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4101 MAIN ST
Practice Address - Street 2:PROFESSIONAL PLAZA UNIT F
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-4608
Practice Address - Country:US
Practice Address - Phone:843-681-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCE12448Medicare UPIN
SC6952Medicare PIN