Provider Demographics
NPI:1750336079
Name:PALMETTO ANESTHESIA ASSOCIATES
Entity type:Organization
Organization Name:PALMETTO ANESTHESIA ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ADELE
Authorized Official - Middle Name:S
Authorized Official - Last Name:LYNAGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-255-1000
Mailing Address - Street 1:PO BOX 63436
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3436
Mailing Address - Country:US
Mailing Address - Phone:855-613-0474
Mailing Address - Fax:864-999-3713
Practice Address - Street 1:1 SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3955
Practice Address - Country:US
Practice Address - Phone:864-848-9555
Practice Address - Fax:864-999-3713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0067Medicaid
SCC14664Medicare PIN
SC3157Medicare PIN