Provider Demographics
NPI:1316242092
Name:PALMETTO CARDIOLOGY OF YORK COUNTY
Entity type:Organization
Organization Name:PALMETTO CARDIOLOGY OF YORK COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:HICKLIN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:803-324-4900
Mailing Address - Street 1:430 S HERLONG AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-9446
Mailing Address - Country:US
Mailing Address - Phone:803-324-4900
Mailing Address - Fax:803-324-1155
Practice Address - Street 1:430 S HERLONG AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-9446
Practice Address - Country:US
Practice Address - Phone:803-324-4900
Practice Address - Fax:803-324-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-11
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP5612Medicaid
SCGP5612Medicaid