Provider Demographics
NPI:1831262237
Name:PALMETTO MEDICAL EQUIPMENT & SUPPLIES
Entity type:Organization
Organization Name:PALMETTO MEDICAL EQUIPMENT & SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SELLERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-623-5600
Mailing Address - Street 1:PO BOX 636
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:SC
Mailing Address - Zip Code:29709-0636
Mailing Address - Country:US
Mailing Address - Phone:843-623-5600
Mailing Address - Fax:843-623-5722
Practice Address - Street 1:13617 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:SC
Practice Address - Zip Code:29709-8209
Practice Address - Country:US
Practice Address - Phone:843-623-5600
Practice Address - Fax:843-623-5722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2750Medicaid
SC5630730001Medicare ID - Type Unspecified