Active NPI
Palmetto Health
- Pediatrics Physician
- Lexington, SC
National Provider Identifier
1871538397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- Legal business name
- PALMETTO HEALTH
- Practice address
- 1316 N Lake Dr
Lexington, SC 29072-7653 - Phone
- (803) 296-7304
- Fax
- (803) 296-7329
- NPI assigned
- Jun 18, 2006
- Organization subpart
- Yes
- Parent organization
- PALMETTO HEALTH ALLIANCE
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Darrell C Coven
- Title
- Director of Business Dev., Finance
- Phone
- (803) 296-7301
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | Primary |
Addresses
Primary practice location
1316 N Lake Dr
Lexington, SC 29072-7653
Mailing address
PO Box 402145
Atlanta, GA 30384-2145
Phone (803) 296-7313
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GP2275 | Medicaid | SC |
Other names 1
- Medical Park Pediatrics
National Provider Directory
National Provider Directory- Part of
- Markowitz and Associates
Locations
1316 N Lake Dr
Lexington, SC 29072
Phone (803) 358-1191
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150588800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1198713600000",
"number": "1871538397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 402145",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303842145",
"telephone_number": "803-296-7313",
"fax_number": "803-296-7330"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1316 N LAKE DR",
"city": "LEXINGTON",
"state": "SC",
"postal_code": "290727653",
"telephone_number": "803-296-7304",
"fax_number": "803-296-7329"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PALMETTO HEALTH",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "PALMETTO HEALTH ALLIANCE",
"enumeration_date": "2006-06-18",
"last_updated": "2007-12-27",
"status": "A",
"authorized_official_last_name": "COVEN",
"authorized_official_first_name": "DARRELL",
"authorized_official_middle_name": "C",
"authorized_official_title_or_position": "DIRECTOR OF BUSINESS DEV., FINANCE",
"authorized_official_telephone_number": "803-296-7301"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Pediatrics",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GP2275",
"state": "SC"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Medical Park Pediatrics",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Lexington, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.