Provider Demographics
NPI:1750579561
Name:PALMETTO HEARING CARE CENTER, LLC
Entity type:Organization
Organization Name:PALMETTO HEARING CARE CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BISH
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:843-594-3032
Mailing Address - Street 1:PO BOX 51025
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-1025
Mailing Address - Country:US
Mailing Address - Phone:843-594-3032
Mailing Address - Fax:843-285-5921
Practice Address - Street 1:9730 DORCHESTER RD UNIT 206
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-9034
Practice Address - Country:US
Practice Address - Phone:843-594-3032
Practice Address - Fax:843-285-5921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4864Medicaid
SCGP4864Medicaid