Provider Demographics
NPI:1629133053
Name:PALMETTO ORTHOTIC, PROSTHETIC AND PEDORTHIC CENTER LLC
Entity type:Organization
Organization Name:PALMETTO ORTHOTIC, PROSTHETIC AND PEDORTHIC CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:ABC CO, CPED
Authorized Official - Phone:479-806-6079
Mailing Address - Street 1:90 SPRINGVIEW LN STE B
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8153
Mailing Address - Country:US
Mailing Address - Phone:843-439-5311
Mailing Address - Fax:843-948-6212
Practice Address - Street 1:90 SPRINGVIEW LN STE B
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8153
Practice Address - Country:US
Practice Address - Phone:843-439-5311
Practice Address - Fax:843-948-6212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200099100AMedicaid
AR342023285OtherAR PIPE TRADES
AR342023285OtherAETNA US HEALTH
AR342023285OtherAARP HEALTHC., PHILADELPH
AR342023285OtherAARP, UHC, ATLANTA GA
AR342023285OtherAR CARBIDE SAW & TOOL CO.
AR342023285OtherAETNA
AR342023285OtherBCBS OF OKLAHOMA
AR49898OtherBCBS
AR29622OtherABP ADMINISTRATION
AR342023285OtherAETNA, POBOX 981107
AR342023285OtherAR FIRST SOURCE
AR342023285OtherAM. PIONEER PENSACOLA FL
AR342023285OtherBANKERS LIFE & CASUALTY
AR156229716Medicaid
AR342023285OtherAARP , UHC, PHILADELPHI
AR342023285OtherAR BEST BENEFITS FSMITH
AR342023285OtherAETNA, POBOX 14079
AR342023285OtherAMCO LITTLE ROCK