Provider Demographics
NPI:1154423556
Name:PALMETTO INTERNAL MEDICINE PA
Entity type:Organization
Organization Name:PALMETTO INTERNAL MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-254-2800
Mailing Address - Street 1:1701 DEVONSHIRE DR
Mailing Address - Street 2:SUITE #101
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204
Mailing Address - Country:US
Mailing Address - Phone:803-254-2800
Mailing Address - Fax:803-254-2890
Practice Address - Street 1:1701 DEVONSHIRE DR
Practice Address - Street 2:SUITE #101
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204
Practice Address - Country:US
Practice Address - Phone:803-254-2800
Practice Address - Fax:803-254-2890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C61172Medicare UPIN
Q242404108Medicare UPIN