Provider Demographics
NPI:1811082928
Name:PALMETTO HEALTH
Entity type:Organization
Organization Name:PALMETTO HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:O
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-855-1644
Mailing Address - Street 1:403 HILLCREST DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-1207
Mailing Address - Country:US
Mailing Address - Phone:864-855-1644
Mailing Address - Fax:864-855-6101
Practice Address - Street 1:403 HILLCREST DR
Practice Address - Street 2:SUITE C
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-1207
Practice Address - Country:US
Practice Address - Phone:864-855-1644
Practice Address - Fax:864-855-6101
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PALMETTO HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-04
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC572296052070OtherBLUE CROSS BLUE SHIELD
SCPC6855Medicaid
SC=========574OtherBLUE CHOICE
SC572296052070OtherBLUE CROSS BLUE SHIELD