# PALMETTO FERTILITY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CCRM Fertility
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609761329
- **Authorized official:** MATT TYSON (DIRECTOR, MANAGED CARE CONTRACTING)
- **Authorized official phone:** (615) 477-6677

## Contact information

- **Practice address:** 700 EXECUTIVE CENTER DR STE 300, GREENVILLE, SC 29615-4555
- **Practice address phone:** (864) 412-1950
- **Practice address fax:** (864) 412-0640
- **Mailing address:** 700 EXECUTIVE CENTER DR STE 300, GREENVILLE, SC 29615-4555
- **Mailing address phone:** (864) 412-1950
- **Mailing address fax:** (864) 412-0640

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/11/2025
- **Last updated:** 04/01/2026