Palmetto Pirate Provisions, LLC

Primary specialty

Meals ProviderTaxonomy code 174200000X

Legal business name

PALMETTO PIRATE PROVISIONS, LLC

Doing business as

Primal Gourmet

Practice address

725 Meeting St
West Columbia, SC 29169-7304

Phone

(803) 530-7557

NPI assigned

Nov 4, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gregory Hugh Martin, CDM, CFPP

Title

Owner

Phone

(803) 530-7557

Specialties & licenses 1

Addresses

Other names 1

• Primal Gourmet Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1635984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635984000000",
    "number": "1285399154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 MEETING ST",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "291697304",
            "telephone_number": "803-530-7557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 MEETING ST",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "291697304",
            "telephone_number": "803-530-7557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMETTO PIRATE PROVISIONS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-04",
        "last_updated": "2021-11-04",
        "certification_date": "2021-11-02",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "HUGH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "803-530-7557",
        "authorized_official_credential": "CDM, CFPP"
    },
    "taxonomies": [
        {
            "code": "174200000X",
            "taxonomy_group": "",
            "desc": "Meals",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Primal Gourmet",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Kelly Pappas

• Meals Provider in West Columbia, SC
• Providers in West Columbia, SC by specialty
• Meals Provider in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.