Provider Demographics
NPI:1629039102
Name:PALMETTO SURGERY LLC
Entity Type:Organization
Organization Name:PALMETTO SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARAREH
Authorized Official - Middle Name:V
Authorized Official - Last Name:BORHANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-324-5858
Mailing Address - Street 1:PO BOX 36548
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-0509
Mailing Address - Country:US
Mailing Address - Phone:803-324-5858
Mailing Address - Fax:803-324-5585
Practice Address - Street 1:1578 CONSTITUTION BLVD
Practice Address - Street 2:01
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3004
Practice Address - Country:US
Practice Address - Phone:803-324-5858
Practice Address - Fax:803-324-5585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-01
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty