# PALMETTO MOON ANESTHESIA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477056794
- **Authorized official:** MS. LINDSEY ANNE CLARK CRNA (EMPLOYEE/MEMBER)
- **Authorized official phone:** (843) 861-3671

## Contact information

- **Practice address:** 3045 ST. MATTHEWS RD., ORANGEBURG, SC 29118
- **Practice address phone:** (843) 861-3671
- **Practice address fax:** (803) 490-1571
- **Mailing address:** 307 WINDING BROOK DR, CAMERON, SC 29030-8347
- **Mailing address phone:** (843) 861-3671
- **Mailing address fax:** (803) 490-1571

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | 3877 | SC | Yes |

## Other

- **Enumeration date:** 03/13/2018
- **Last updated:** 03/13/2018