Provider Demographics
NPI:1457432478
Name:PALMETTO HEALTH
Entity Type:Organization
Organization Name:PALMETTO HEALTH
Other - Org Name:PALMETTO SENIORCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PFS
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:ECKERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-296-2548
Mailing Address - Street 1:PALMETTO HEALTH SENIORCARE
Mailing Address - Street 2:3555 HARDEN STREET 15 MEDICAL PARK SUITE203
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:803-296-2548
Mailing Address - Fax:803-296-3040
Practice Address - Street 1:PALMETTO HEALTH
Practice Address - Street 2:15 MEDICAL PARK DRIVE SUITE203
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-296-2548
Practice Address - Fax:803-296-3040
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PALMETTO HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-17
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX0158Medicaid
SCH4203Medicare UPIN
SCEX0158Medicaid