Palmetto Allergy & Asthma Pa | |
Ste 430 9 Richland Medical Pk Columbia SC 29203-6870 | |
(803) 765-9435 | |
(803) 765-2446 |
Full Name | Palmetto Allergy & Asthma Pa |
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Speciality | Clinic/Center |
Location | Ste 430, Columbia, South Carolina |
Authorized Official Name and Position | Lisa S Hutto (PHYSICIAN) |
Authorized Official Contact | 8037659435 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Palmetto Allergy & Asthma Pa Ste 430 9 Richland Medical Pk Columbia SC 29203-6870 Ph: (803) 765-9435 | Palmetto Allergy & Asthma Pa Ste 430 9 Richland Medical Pk Columbia SC 29203-6870 Ph: (803) 765-9435 |
NPI Number | 1891754651 |
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Provider Enumeration Date | 03/21/2006 |
Last Update Date | 06/07/2017 |
Medicare PECOS PAC ID | 8426017856 |
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Medicare Enrollment ID | O20041011000017 |
Identifier | Type | State | Issuer |
---|---|---|---|
1891754651 | NPI | - | NPPES |
12987 | Other | SC | SC STATE MED LIC # |
GP1022 | Medicaid | SC | |
1528012960 | Other | SC | INDIVIDUAL NPI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Provider Name | Lisa Hutto |
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Provider Type | Practitioner - Allergy/immunology |
Provider Identifiers | NPI Number: 1528012960 PECOS PAC ID: 2567588791 Enrollment ID: I20100924001288 |
Northlake Family Medical Practice Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3000 Ne Medical Park, Ste 101, Columbia, SC 29223 Phone: 803-419-5131 Fax: 803-419-5130 | |
Lagniappe Medical Clinics, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 74 Polo Rd, Columbia, SC 29223 Phone: 803-419-7780 Fax: 803-419-7781 | |