| Palss | |
|
2638 Two Notch Rd Suite 108 Columbia SC 29204-1454 | |
| (803) 779-7257 | |
| (803) 779-5285 |
| Full Name | Palss |
|---|---|
| Speciality | Clinic/Center |
| Location | 2638 Two Notch Rd, Columbia, South Carolina |
| Authorized Official Name and Position | Carmen Hampton Julious (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8037797257 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Palss 2638 Two Notch Rd Suite 108 Columbia SC 29204-1454 Ph: (803) 779-7257 | Palss 2638 Two Notch Rd Suite 108 Columbia SC 29204-1454 Ph: (803) 779-7257 |
| NPI Number | 1184829392 |
|---|---|
| Provider Enumeration Date | 06/18/2007 |
| Last Update Date | 03/03/2015 |
| Medicare PECOS PAC ID | 8527417682 |
|---|---|
| Medicare Enrollment ID | O20231214001248 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184829392 | NPI | - | NPPES |
| EX0210 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (South Carolina) | Primary |
| Provider Name | Leroy J Huffman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1881689032 PECOS PAC ID: 0840283644 Enrollment ID: I20051005000912 |
| Provider Name | Towanna Shanett Lance Enoch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982709069 PECOS PAC ID: 1254568355 Enrollment ID: I20210526002470 |
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