Provider Demographics
NPI:1134454184
Name:PALMETTO MEDICAL CENTER
Entity type:Organization
Organization Name:PALMETTO MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:HAVEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:843-342-3333
Mailing Address - Street 1:20 TOWNE DR
Mailing Address - Street 2:SUITE 398
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-4204
Mailing Address - Country:US
Mailing Address - Phone:843-342-3333
Mailing Address - Fax:843-342-3367
Practice Address - Street 1:60 MAIN ST
Practice Address - Street 2:SUITE G
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-6602
Practice Address - Country:US
Practice Address - Phone:843-342-3333
Practice Address - Fax:843-342-3367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-08
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC9524Medicare PIN