1013041367 NPI number — PALMETTO HEATLH

Table of content: HEATHER N. TARANTINO MD (NPI 1235284084)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013041367 NPI number — PALMETTO HEATLH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PALMETTO HEATLH
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:
6
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:
1013041367
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 744244
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-4244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-296-2548
Provider Business Mailing Address Fax Number:
803-296-2548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3301 HARDEN ST EXT 5 MEDICAL PARK
Provider Second Line Business Practice Location Address:
PALMETTO HEALTH CRNA RICHLAND
Provider Business Practice Location Address City Name:
COULMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29203-6813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-296-2548
Provider Business Practice Location Address Fax Number:
803-296-2548
Provider Enumeration Date:
03/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
WILLIE
Authorized Official Middle Name:
P
Authorized Official Title or Position:
DIRECTOR OF PATIENT ACCOUNTS
Authorized Official Telephone Number:
803-296-2342

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X , 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: SUFFIX 008 . This is a "BCBS CRNA RICHLAND" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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