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Organization

PALMETTO HEALTH

Active
Parent organization
PALMETTO HEALTH ALLIANCE
Other names
Pediatric Urology
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
9 RICHLAND MEDICAL PARK, SUITE 420, COLUMBIA, SC 29203-6859
(803) 434-2833
(803) 434-2834
Mailing address
PO BOX 402145, ATLANTA, GA 30384-2145
(803) 296-7313
(803) 296-7330

Taxonomy

Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
GP4066
SC
Enumeration date
06/19/2006
Last updated
01/02/2008
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