Provider Demographics
NPI:1467526459
Name:PALMETTO ENT CONSULTANTS, P.A.
Entity Type:Organization
Organization Name:PALMETTO ENT CONSULTANTS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DRAFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-256-7076
Mailing Address - Street 1:2801 DEVINE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-2511
Mailing Address - Country:US
Mailing Address - Phone:803-256-7076
Mailing Address - Fax:803-256-0961
Practice Address - Street 1:2801 DEVINE ST STE 101
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-2511
Practice Address - Country:US
Practice Address - Phone:803-256-7076
Practice Address - Fax:803-256-0961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & NeurotologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1647Medicare PIN