Provider Demographics
NPI:1336303288
Name:PALMETTO GENERAL OUTPATIENT SERVICES
Entity Type:Organization
Organization Name:PALMETTO GENERAL OUTPATIENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:L
Authorized Official - Last Name:GUADAGNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-499-7320
Mailing Address - Street 1:7392 NW 35TH TER
Mailing Address - Street 2:SUITE # 305
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1271
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7392 NW 35TH TER
Practice Address - Street 2:SUITE # 305
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33122-1271
Practice Address - Country:US
Practice Address - Phone:786-499-7320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty