Basic Information
| Provider Information | |||||||||
| NPI: | 1023457389 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE REGIONAL MEDICAL CENTER OF ORANGEBURG AND CALHOUN COUNTIES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PALMETTO SURGICAL GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1245 | ||||||||
| Address2: | |||||||||
| City: | ORANGEBURG | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291161245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8033954497 | ||||||||
| FaxNumber: | 8033952237 | ||||||||
| Practice Location | |||||||||
| Address1: | 1175 COOK RD STE 320 | ||||||||
| Address2: | |||||||||
| City: | ORANGEBURG | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291188247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8033953960 | ||||||||
| FaxNumber: | 8033952237 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2013 | ||||||||
| LastUpdateDate: | 11/09/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | FULMER | ||||||||
| AuthorizedOfficialFirstName: | CHRISTAL | ||||||||
| AuthorizedOfficialMiddleName: | LEANN | ||||||||
| AuthorizedOfficialTitleorPosition: | REVENUE INTEGRITY MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8033954248 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | THE REGIONAL MEDICAL CENTER OF ORANGEBURG AND CALHOUN COUNTIES | ||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | 11/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 208600000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.