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
—
—
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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