Provider Demographics
NPI:1043244031
Name:PLAYMAKERS III LLC
Entity Type:Organization
Organization Name:PLAYMAKERS III LLC
Other - Org Name:THE FOOT STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:ROBERTA
Authorized Official - Last Name:VARNDELL
Authorized Official - Suffix:
Authorized Official - Credentials:CPED ATC
Authorized Official - Phone:843-849-1108
Mailing Address - Street 1:1909 HWY 17N
Mailing Address - Street 2:SUITE S
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464
Mailing Address - Country:US
Mailing Address - Phone:843-849-1108
Mailing Address - Fax:843-849-1170
Practice Address - Street 1:1909 HWY 17N
Practice Address - Street 2:SUITE S
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464
Practice Address - Country:US
Practice Address - Phone:843-849-1108
Practice Address - Fax:843-849-1170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2008Medicaid
SCDE2008Medicaid