Provider Demographics
NPI:1891754651
Name:PALMETTO ALLERGY & ASTHMA PA
Entity Type:Organization
Organization Name:PALMETTO ALLERGY & ASTHMA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HUTTO
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:803-765-9435
Mailing Address - Street 1:STE 430
Mailing Address - Street 2:9 RICHLAND MEDICAL PK
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6870
Mailing Address - Country:US
Mailing Address - Phone:803-765-9435
Mailing Address - Fax:803-765-2446
Practice Address - Street 1:STE 430
Practice Address - Street 2:9 RICHLAND MEDICAL PK
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6870
Practice Address - Country:US
Practice Address - Phone:803-765-9435
Practice Address - Fax:803-765-2446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC12987OtherSC STATE MED LIC #
SCGP1022Medicaid
SC1528012960OtherINDIVIDUAL NPI
SC1528012960OtherINDIVIDUAL NPI
SCGP1022Medicaid
SCE50290Medicare UPIN