Provider Demographics
NPI:1851983126
Name:PALMETTO TRANSPORT SERVICE, LLC
Entity Type:Organization
Organization Name:PALMETTO TRANSPORT SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:BRANNON
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-374-4677
Mailing Address - Street 1:61 OSPREY CIR
Mailing Address - Street 2:
Mailing Address - City:OKATIE
Mailing Address - State:SC
Mailing Address - Zip Code:29909-4228
Mailing Address - Country:US
Mailing Address - Phone:803-374-4677
Mailing Address - Fax:843-279-3158
Practice Address - Street 1:61 OSPREY CIR
Practice Address - Street 2:
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909-4228
Practice Address - Country:US
Practice Address - Phone:803-374-4677
Practice Address - Fax:843-279-3158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC21029024100644Medicaid