Provider Demographics
NPI:1194122598
Name:PALMETTO FAMILY MEDICINE AND SENIOR CARE, LLC
Entity type:Organization
Organization Name:PALMETTO FAMILY MEDICINE AND SENIOR CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROPP
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:843-917-4977
Mailing Address - Street 1:420 W CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-4524
Mailing Address - Country:US
Mailing Address - Phone:843-917-4977
Mailing Address - Fax:843-639-8145
Practice Address - Street 1:420 W CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-4524
Practice Address - Country:US
Practice Address - Phone:843-917-4977
Practice Address - Fax:888-854-0390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23144207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC231449Medicaid
SC231966Medicaid