Provider Demographics
NPI:1861828089
Name:PALMETTO OXYGEN, LLC
Entity Type:Organization
Organization Name:PALMETTO OXYGEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-880-0473
Mailing Address - Street 1:104 CORPORATE BLVD STE 402
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-4600
Mailing Address - Country:US
Mailing Address - Phone:803-926-0252
Mailing Address - Fax:
Practice Address - Street 1:1906 MEETING CT
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6631
Practice Address - Country:US
Practice Address - Phone:910-491-4334
Practice Address - Fax:910-491-4334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-19
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC02098332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02098OtherNC BOARD OF PHARMACY