Provider Demographics
NPI:1811087539
Name:PALMETTO KIDNEY AND HYPERTENSION LLC
Entity type:Organization
Organization Name:PALMETTO KIDNEY AND HYPERTENSION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:ELLINGTON
Authorized Official - Last Name:CHEEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-573-0858
Mailing Address - Street 1:2093 HENRY TECKLENBURG DRIVE
Mailing Address - Street 2:STE 307
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5743
Mailing Address - Country:US
Mailing Address - Phone:843-766-9105
Mailing Address - Fax:843-402-9925
Practice Address - Street 1:2093 HENRY TECKLENBURG DRIVE
Practice Address - Street 2:SUITE 307
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5741
Practice Address - Country:US
Practice Address - Phone:843-573-0858
Practice Address - Fax:843-573-0859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14170207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4468Medicaid
SC8341Medicare PIN
SCGP4468Medicaid