Provider Demographics
NPI:1962480046
Name:MYRTLE BEACH BRACE & LIMB CENTER, LLC
Entity Type:Organization
Organization Name:MYRTLE BEACH BRACE & LIMB CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-444-0405
Mailing Address - Street 1:1508 HWY 501 WEST
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-9746
Mailing Address - Country:US
Mailing Address - Phone:843-444-0405
Mailing Address - Fax:843-444-0507
Practice Address - Street 1:1508 HWY 501 WEST
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-9746
Practice Address - Country:US
Practice Address - Phone:843-444-0405
Practice Address - Fax:843-444-0507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDME699Medicaid
SCDME699Medicaid