Provider Demographics
NPI:1508809906
Name:PALMETTO ENDOCRINE ASSOCIATES, INC.
Entity Type:Organization
Organization Name:PALMETTO ENDOCRINE ASSOCIATES, INC.
Other - Org Name:PALMETTO ENDOCRINE ASSOCIATES, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGING PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-515-9744
Mailing Address - Street 1:1709 VILLAGE PARK DR
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-2401
Mailing Address - Country:US
Mailing Address - Phone:803-515-9744
Mailing Address - Fax:803-515-9733
Practice Address - Street 1:1709 VILLAGE PARK DR
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2401
Practice Address - Country:US
Practice Address - Phone:803-515-9744
Practice Address - Fax:803-515-9733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4264Medicaid
SCGP4264Medicaid
SCGP4264Medicaid
SCH09724Medicare UPIN