Provider Demographics
NPI:1558614628
Name:PALMETTO SERVICE COMPANY LLC
Entity Type:Organization
Organization Name:PALMETTO SERVICE COMPANY LLC
Other - Org Name:PALMETTO GERIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-312-3595
Mailing Address - Street 1:1831 W EVANS ST
Mailing Address - Street 2:230
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-3333
Mailing Address - Country:US
Mailing Address - Phone:859-312-3595
Mailing Address - Fax:
Practice Address - Street 1:1831 W EVANS ST
Practice Address - Street 2:230
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-3333
Practice Address - Country:US
Practice Address - Phone:859-312-3595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty