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:PERKINS ORTHOTIC, PROSTHETIC AND PEDORTHIC CENTER
Other - Org Type:Doing Business As
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:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:WADMALAW ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29487-0067
Mailing Address - Country:US
Mailing Address - Phone:479-806-6079
Mailing Address - Fax:
Practice Address - Street 1:107 W 5TH NORTH ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6446
Practice Address - Country:US
Practice Address - Phone:479-806-6079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR342023285OtherAM. PIONEER PENSACOLA FL
OK200099100AMedicaid
AR342023285OtherAR FIRST SOURCE
AR342023285OtherAETNA, POBOX 981107
AR156229716Medicaid
AR342023285OtherBCBS OF OKLAHOMA
AR342023285OtherAR PIPE TRADES
AR342023285OtherAARP HEALTHC., PHILADELPH
AR342023285OtherAARP, UHC, ATLANTA GA
AR342023285OtherAETNA US HEALTH
AR342023285OtherAETNA
AR342023285OtherAMCO LITTLE ROCK
AR49898OtherBCBS
AR342023285OtherAR CARBIDE SAW & TOOL CO.
AR29622OtherABP ADMINISTRATION
AR342023285OtherAARP , UHC, PHILADELPHI
AR342023285OtherAR BEST BENEFITS FSMITH
AR342023285OtherAETNA, POBOX 14079
AR342023285OtherBANKERS LIFE & CASUALTY