Provider Demographics
NPI:1932132073
Name:PALMETTO STATE STAFFING GROUP, LLC
Entity Type:Organization
Organization Name:PALMETTO STATE STAFFING GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOMER
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:GAMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-413-0609
Mailing Address - Street 1:113 CHEROKEE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-5247
Mailing Address - Country:US
Mailing Address - Phone:843-413-0609
Mailing Address - Fax:843-413-0626
Practice Address - Street 1:113 CHEROKEE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5247
Practice Address - Country:US
Practice Address - Phone:843-413-0609
Practice Address - Fax:843-413-0626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC07141261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC207141Medicaid
SCD90884Medicare UPIN