Provider Demographics
NPI:1194308882
Name:PALMETTO KIDNEY AND HYPERTENSION ASSOCIATES LLC
Entity type:Organization
Organization Name:PALMETTO KIDNEY AND HYPERTENSION ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:OSAGUONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-722-4001
Mailing Address - Street 1:2601 LAUREL ST STE 230
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2034
Mailing Address - Country:US
Mailing Address - Phone:803-722-4001
Mailing Address - Fax:803-205-4008
Practice Address - Street 1:2601 LAUREL ST STE 230
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2034
Practice Address - Country:US
Practice Address - Phone:803-722-4001
Practice Address - Fax:803-205-4008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty