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Organization
PALMETTO HEALTH
Active
Organization
PALMETTO HEALTH
Active
Parent organization
PALMETTO HEALTH ALLIANCE
Other names
Medical Park Pediatrics
Organization subpart
Yes
Provider details
NPI number
Legal business name
PALMETTO HEALTH ALLIANCE
Authorized official
DARRELL C COVEN (DIRECTOR OF BUSINESS DEV., FINANCE)
(803) 296-7301
Entity
Organization
Contact information
Practice address
1316 N LAKE DR, LEXINGTON, SC 29072-7653
(803) 296-7304
(803) 296-7329
Mailing address
PO BOX 402145, ATLANTA, GA 30384-2145
(803) 296-7313
(803) 296-7330
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
NULL
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP2275
—
SC
Enumeration date
06/18/2006
Last updated
12/27/2007
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