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Organization

PALMETTO HEALTH

Active
Parent organization
PALMETTO HEALTH
Other names
Twelve Mile Creek Family Medicine
Organization subpart
Yes

Provider details

NPI number
Legal business name
PALMETTO HEALTH
Authorized official
MR. DARRELL C COVEN (DIRECTOR - BUSINESS DEV/FINANCE)
(803) 296-7301
Entity
Organization

Contact information

Practice address
4711 SUNSET BLVD, LEXINGTON, SC 29072-9151
(803) 356-3609
(803) 356-3941
Mailing address
PO BOX 402145, ATLANTA, GA 30384-2145
(803) 296-7306
(803) 296-7329

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
GP5017
SC
Enumeration date
08/04/2008
Last updated
02/11/2009
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