Provider Demographics
NPI:1194837849
Name:PALMETTO SURGICAL ASSOCIATES PA
Entity type:Organization
Organization Name:PALMETTO SURGICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:METROPOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-254-4707
Mailing Address - Street 1:1333 TAYLOR ST
Mailing Address - Street 2:STE 3A
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201
Mailing Address - Country:US
Mailing Address - Phone:803-254-4707
Mailing Address - Fax:803-254-1198
Practice Address - Street 1:1333 TAYLOR ST
Practice Address - Street 2:STE 3A
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201
Practice Address - Country:US
Practice Address - Phone:803-254-4707
Practice Address - Fax:803-254-1198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA0873Medicaid
SCPA0873Medicaid