Provider Demographics
NPI:1518024868
Name:PALMETTO CARDIOVASCULAR AND THORACIC ASSOC PA
Entity Type:Organization
Organization Name:PALMETTO CARDIOVASCULAR AND THORACIC ASSOC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT THORACIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BENNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-553-5616
Mailing Address - Street 1:9231 MEDICAL PLAZA DR STE D
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9101
Mailing Address - Country:US
Mailing Address - Phone:843-553-5616
Mailing Address - Fax:843-764-2917
Practice Address - Street 1:9231 MEDICAL PLAZA DR STE D
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9101
Practice Address - Country:US
Practice Address - Phone:843-553-5616
Practice Address - Fax:843-764-2917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty