Provider Demographics
NPI:1386164861
Name:PALMETTO BIOTECH PROSTHETICS & ORTHOTICS LLC
Entity type:Organization
Organization Name:PALMETTO BIOTECH PROSTHETICS & ORTHOTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:WALKER
Authorized Official - Last Name:MURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:BOCP, BOCO
Authorized Official - Phone:843-295-7338
Mailing Address - Street 1:2419 DEVINE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-2405
Mailing Address - Country:US
Mailing Address - Phone:803-814-2778
Mailing Address - Fax:803-851-4019
Practice Address - Street 1:2419 DEVINE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-2405
Practice Address - Country:US
Practice Address - Phone:803-814-2778
Practice Address - Fax:803-851-4019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty