Provider Demographics
NPI:1710428321
Name:PALMETTO HEALTH USC MEDICAL GROUP
Entity Type:Organization
Organization Name:PALMETTO HEALTH USC MEDICAL GROUP
Other - Org Name:BIMA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-296-5678
Mailing Address - Street 1:TAYLOR @ MARION ST.
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29220
Mailing Address - Country:US
Mailing Address - Phone:803-296-5678
Mailing Address - Fax:
Practice Address - Street 1:TAYLOR MARION STS
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29220-0001
Practice Address - Country:US
Practice Address - Phone:803-296-5579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST INPATIENT MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20850282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital