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Organization

PALMETTO HEALTH ALLIANCE

Active
Other names
Center for Pain Management
Organization subpart
No

Provider details

NPI number
Authorized official
BERNICE K RICHARDSON (MEDICAL AFFAIRS MANAGER)
(803) 254-2394
Entity
Organization

Contact information

Practice address
223 STONERIDGE DR, COLUMBIA, SC 29210-8009
(803) 296-5990
(803) 296-2400
Mailing address
PO BOX 1669, COLUMBIA, SC 29202-1669
(803) 254-2394
(803) 254-7125

Taxonomy

Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
DA2317
RR MEDICARE
SC
01
GP3454
SELECT HEALTH
SC
05
GP3454
SC
Enumeration date
10/04/2006
Last updated
08/22/2020
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