Provider Demographics
NPI:1740376052
Name:PALMETTO FAMILY MEDICINE
Entity type:Organization
Organization Name:PALMETTO FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:ZEAGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-268-2333
Mailing Address - Street 1:3551A RUTHERFORD RD
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-2195
Mailing Address - Country:US
Mailing Address - Phone:864-268-2333
Mailing Address - Fax:
Practice Address - Street 1:3551A RUTHERFORD RD
Practice Address - Street 2:
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-2195
Practice Address - Country:US
Practice Address - Phone:864-268-2333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2463Medicaid
SC3926740001Medicare NSC
SC6259Medicare PIN
SCB92257Medicare UPIN