Provider Demographics
NPI:1972548634
Name:PALMETTO HEALTH
Entity type:Organization
Organization Name:PALMETTO HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEELBINDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-855-5006
Mailing Address - Street 1:1351 CRESTVIEW RD
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-2408
Mailing Address - Country:US
Mailing Address - Phone:864-855-5006
Mailing Address - Fax:864-850-1992
Practice Address - Street 1:1351 CRESTVIEW RD
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-2408
Practice Address - Country:US
Practice Address - Phone:864-855-5006
Practice Address - Fax:864-850-1992
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PALMETTO HEALTH ALLIANCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-18
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3292Medicaid
SCGP3292Medicaid
SC7265Medicare PIN