Provider Demographics
NPI:1942290036
Name:PALMETTO PREFERRED, OB/GYN, LLC
Entity Type:Organization
Organization Name:PALMETTO PREFERRED, OB/GYN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:TOWNSEND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-286-4405
Mailing Address - Street 1:834 WEST MEETING STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-6261
Mailing Address - Country:US
Mailing Address - Phone:803-286-4405
Mailing Address - Fax:803-286-8487
Practice Address - Street 1:834 WEST MEETING STREET
Practice Address - Street 2:SUITE B
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-6261
Practice Address - Country:US
Practice Address - Phone:803-286-4405
Practice Address - Fax:803-286-8487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207V00000X
SC12398207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2348Medicaid
6177Medicare ID - Type Unspecified
SCGP2348Medicaid
D990806177Medicare PIN