Provider Demographics
NPI:1891748356
Name:PALMETTO ANESTHESIA AND PAIN, LLC
Entity Type:Organization
Organization Name:PALMETTO ANESTHESIA AND PAIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:COGGINS
Authorized Official - Last Name:DEVOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-682-2345
Mailing Address - Street 1:222 PEMBROKE DR
Mailing Address - Street 2:BUILDING C
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-6201
Mailing Address - Country:US
Mailing Address - Phone:843-682-2345
Mailing Address - Fax:843-682-2343
Practice Address - Street 1:222 PEMBROKE DR
Practice Address - Street 2:BUILDING C
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-6201
Practice Address - Country:US
Practice Address - Phone:843-682-2345
Practice Address - Fax:843-682-2343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Not Answered207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3894Medicaid
SC=========OtherBLUE CROSS BLUE SHIELD
SC=========OtherBLUE CROSS BLUE SHIELD