Organization
PALMETTO HEALTH
Active
Parent organization
PALMETTO HEALTH ALLIANCE
Other names
Midlands Internal Medicine
Organization subpart
Yes
Provider details
NPI number
Legal business name
PALMETTO HEALTH ALLIANCE
Authorized official
DARRELL C COVEN (DIRECTOR, AMBULATORY SVCS - FINANCE)
(803) 296-7301
Entity
Organization
Contact information
Practice address
3000 NE MEDICAL PARK, SUITE 108, COLUMBIA, SC 29223-6251
(803) 462-9200
(803) 699-1474
Mailing address
PO BOX 402145, ATLANTA, GA 30384-2145
(803) 296-7305
(803) 296-7330
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CG5471
MEDICARE RAILROAD GROUP PTAN
SC
05
—
GP2081
—
SC
Enumeration date
07/21/2006
Last updated
01/22/2010
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