Provider Demographics
NPI:1508825340
Name:PALMETTO FAMILY MEDICINE
Entity Type:Organization
Organization Name:PALMETTO FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:J.
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:M D
Authorized Official - Phone:803-256-2286
Mailing Address - Street 1:109 BARTON CREEK COURT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-8027
Mailing Address - Country:US
Mailing Address - Phone:803-256-2286
Mailing Address - Fax:803-343-2115
Practice Address - Street 1:109 BARTON CREEK COURT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-8027
Practice Address - Country:US
Practice Address - Phone:803-256-2286
Practice Address - Fax:803-343-2115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13700261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA1319Medicaid
SC6260340001Medicare NSC
SC7164Medicare PIN
SCD18292Medicare UPIN
SCPA1319Medicaid
SCE29393Medicare UPIN