Provider Demographics
NPI:1255397840
Name:PALMETTO INFECTIOUS DISEASE PHYSICIANS
Entity type:Organization
Organization Name:PALMETTO INFECTIOUS DISEASE PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HUNTER
Authorized Official - Last Name:SAMIES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-539-0505
Mailing Address - Street 1:2850 JACKSON DR
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-3156
Mailing Address - Country:US
Mailing Address - Phone:803-539-0505
Mailing Address - Fax:803-539-0410
Practice Address - Street 1:1097B COOK RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-8209
Practice Address - Country:US
Practice Address - Phone:803-539-0505
Practice Address - Fax:803-539-0410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19747207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4259Medicaid
SCGP4295Medicaid
SC4259Medicaid