Provider Demographics
NPI:1821220807
Name:PALMETTO IMAGING, INC
Entity Type:Organization
Organization Name:PALMETTO IMAGING, INC
Other - Org Name:INNERVISION MRI & IMAGING AT GROVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.O.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHAEFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-300-0101
Mailing Address - Street 1:PO BOX 933548
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-3548
Mailing Address - Country:US
Mailing Address - Phone:877-527-9375
Mailing Address - Fax:770-300-9018
Practice Address - Street 1:1 CANNON DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4201
Practice Address - Country:US
Practice Address - Phone:864-242-4011
Practice Address - Fax:864-233-2677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-10
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC470000944OtherRAILROAD MEDICARE