Provider Demographics
NPI:1962604165
Name:PALMETTO HEALTH
Entity type:Organization
Organization Name:PALMETTO HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER PATIENT FINANCIAL SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:KENDALL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-855-5104
Mailing Address - Street 1:PO BOX 2089
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29641-2089
Mailing Address - Country:US
Mailing Address - Phone:864-855-5104
Mailing Address - Fax:864-859-9362
Practice Address - Street 1:112 JOHN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-1472
Practice Address - Country:US
Practice Address - Phone:864-855-5104
Practice Address - Fax:864-859-9362
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PALMETTO HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-01
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1093787509OtherROBERSON'S NPI
SCGP4719Medicaid
SC1093787509OtherROBERSON'S NPI
SC=========-585OtherBLUE CHOICE
SC6291Medicare PIN