Provider Demographics
NPI:1932404589
Name:PALMETTO PICC LINES, LLC
Entity Type:Organization
Organization Name:PALMETTO PICC LINES, LLC
Other - Org Name:PALMETTO PICC LINES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-568-2716
Mailing Address - Street 1:PO BOX 12008
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29422-2008
Mailing Address - Country:US
Mailing Address - Phone:843-568-2716
Mailing Address - Fax:
Practice Address - Street 1:5804 CARDIFF CT
Practice Address - Street 2:
Practice Address - City:HANAHAN
Practice Address - State:SC
Practice Address - Zip Code:29410-2402
Practice Address - Country:US
Practice Address - Phone:843-568-2716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC988163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Single Specialty