1033514120 NPI number — PALMETTO HEALTH

Table of content: MILTON CHARLES ZADINA MD (NPI 1427028547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033514120 NPI number — PALMETTO HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PALMETTO HEALTH
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:
1033514120
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 402145
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:
30384-2145
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-296-7305
Provider Business Mailing Address Fax Number:
803-296-7330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 RICHLAND MEDICAL PARK DR
Provider Second Line Business Practice Location Address:
SUITE 2100
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29203-6864
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-434-2762
Provider Business Practice Location Address Fax Number:
803-434-2713
Provider Enumeration Date:
10/31/2014

Additional Information

Authorized Official

Authorized Official Last Name:
COVEN
Authorized Official First Name:
DARRELL
Authorized Official Middle Name:
C
Authorized Official Title or Position:
DIRECTOR, AMBULATORY SRVCS FINANCE
Authorized Official Telephone Number:
803-296-7301

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GP7115 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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