Provider Demographics
NPI:1497731368
Name:PALMETTO SURGERY ASSOCIATES, PA
Entity Type:Organization
Organization Name:PALMETTO SURGERY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMM
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:PALUZZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-888-0909
Mailing Address - Street 1:107 OMNI DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29672-9448
Mailing Address - Country:US
Mailing Address - Phone:864-888-0909
Mailing Address - Fax:864-888-0601
Practice Address - Street 1:107 OMNI DR
Practice Address - Street 2:SUITE B
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-9448
Practice Address - Country:US
Practice Address - Phone:864-888-0909
Practice Address - Fax:864-888-0601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2422Medicaid
SCE41765Medicare UPIN
SC7587Medicare ID - Type Unspecified