Provider Demographics
NPI:1932377223
Name:PICKERING PROSTHETICS
Entity Type:Organization
Organization Name:PICKERING PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PROSTHETICS
Authorized Official - Prefix:MR
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:PICKERING
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:803-534-6567
Mailing Address - Street 1:230 ELLIOTT ST
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115
Mailing Address - Country:US
Mailing Address - Phone:803-534-6567
Mailing Address - Fax:803-534-7280
Practice Address - Street 1:230 ELLIOTT ST
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-6022
Practice Address - Country:US
Practice Address - Phone:803-534-6567
Practice Address - Fax:803-534-7280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2022-07-21
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
SC1275510001Medicare NSC