The Palmetto Skin and Laser Center LLC

Primary specialty

Procedural Dermatology PhysicianTaxonomy code 207NS0135X

Legal business name

THE PALMETTO SKIN AND LASER CENTER LLC

Practice address

1563 Health Care Dr
Rock Hill, SC 29732-3858

Phone

(803) 329-6030

Fax

(803) 329-6035

NPI assigned

Jul 22, 2006

Last updated

Feb 10, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Richard E White, MDNPI 1730165465

Title

Owner Partner

Phone

(803) 329-6030

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Richard Eric White, MD

  • Procedural Dermatology Physician
  • Rock Hill, SC
  • NPI 1730165465
  Medicare reassignment Care Compare group NPD Authorized official
• Timothy Gerrard Woodall, MD

  • Procedural Dermatology Physician
  • Rock Hill, SC
  • NPI 1114902269
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612915200000",
    "number": "1992726269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1563 HEALTH CARE DR",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297323858",
            "telephone_number": "803-329-6030",
            "fax_number": "803-329-6035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1563 HEALTH CARE DR",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297323858",
            "telephone_number": "803-329-6030",
            "fax_number": "803-329-6035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PALMETTO SKIN AND LASER CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2021-02-10",
        "certification_date": "2021-02-10",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER PARTNER",
        "authorized_official_telephone_number": "803-329-6030",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DC3336",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Procedural Dermatology Physician in Rock Hill, SC
• Providers in Rock Hill, SC by specialty
• Procedural Dermatology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.