1922023738 NPI number — PALMETTO OXYGEN, LLC

Table of content: (NPI 1922023738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922023738 NPI number — PALMETTO OXYGEN, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PALMETTO OXYGEN, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922023738
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 W GERMANTOWN PIKE STE 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLYMOUTH MEETING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19462-1437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-388-1719
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1445 SHOP RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29201-4817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-926-0252
Provider Business Practice Location Address Fax Number:
803-926-0236
Provider Enumeration Date:
07/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCGEE
Authorized Official First Name:
LUKE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
646-880-0473

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  65008058 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DE1828 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".