Provider Demographics
NPI:1609761329
Name:PALMETTO FERTILITY, LLC
Entity type:Organization
Organization Name:PALMETTO FERTILITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGED CARE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:RAVECH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-305-6640
Mailing Address - Street 1:700 EXECUTIVE CENTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4555
Mailing Address - Country:US
Mailing Address - Phone:864-412-1950
Mailing Address - Fax:864-412-0640
Practice Address - Street 1:700 EXECUTIVE CENTER DR STE 300
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4555
Practice Address - Country:US
Practice Address - Phone:864-412-1950
Practice Address - Fax:864-412-0640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical