Provider Demographics
NPI:1972808186
Name:PALMETTO ENDOSCOPY SUITE, LLC
Entity Type:Organization
Organization Name:PALMETTO ENDOSCOPY SUITE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:803-509-5710
Mailing Address - Street 1:1520 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2919
Mailing Address - Country:US
Mailing Address - Phone:803-509-5710
Mailing Address - Fax:803-509-5711
Practice Address - Street 1:1520 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2919
Practice Address - Country:US
Practice Address - Phone:803-509-5710
Practice Address - Fax:803-509-5711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0932Medicaid
SCGP0932Medicaid