1629133053 NPI number — PALMETTO ORTHOTIC, PROSTHETIC AND PEDORTHIC CENTER LLC

Table of content: (NPI 1629133053)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629133053 NPI number — PALMETTO ORTHOTIC, PROSTHETIC AND PEDORTHIC CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PALMETTO ORTHOTIC, PROSTHETIC AND PEDORTHIC CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629133053
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
90 SPRINGVIEW LN STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUMMERVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29485-8153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-439-5311
Provider Business Mailing Address Fax Number:
843-948-6212

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
90 SPRINGVIEW LN STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUMMERVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29485-8153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-439-5311
Provider Business Practice Location Address Fax Number:
843-948-6212
Provider Enumeration Date:
12/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PERKINS
Authorized Official First Name:
SHELLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
PART OWNER
Authorized Official Telephone Number:
479-806-6079

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200099100A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 342023285 . This is a "AR PIPE TRADES" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 342023285 . This is a "AETNA US HEALTH" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 342023285 . This is a "AARP HEALTHC., PHILADELPH" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 342023285 . This is a "AARP, UHC, ATLANTA GA" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 342023285 . This is a "AR CARBIDE SAW & TOOL CO." identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 342023285 . This is a "AETNA" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 342023285 . This is a "BCBS OF OKLAHOMA" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 49898 . This is a "BCBS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 29622 . This is a "ABP ADMINISTRATION" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 342023285 . This is a "AETNA, POBOX 981107" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 342023285 . This is a "AR FIRST SOURCE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 342023285 . This is a "AM. PIONEER PENSACOLA FL" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 342023285 . This is a "BANKERS LIFE & CASUALTY" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 156229716 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 342023285 . This is a "AARP , UHC, PHILADELPHI" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 342023285 . This is a "AR BEST BENEFITS FSMITH" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 342023285 . This is a "AETNA, POBOX 14079" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 342023285 . This is a "AMCO LITTLE ROCK" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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