Provider Demographics
NPI:1962420927
Name:BERKELEY FAMILY PRACTICE LLC
Entity type:Organization
Organization Name:BERKELEY FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D. - PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:SANTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-761-8800
Mailing Address - Street 1:2061 HIGHWAY 52
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-5017
Mailing Address - Country:US
Mailing Address - Phone:843-761-8800
Mailing Address - Fax:843-761-8824
Practice Address - Street 1:2061 HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-5017
Practice Address - Country:US
Practice Address - Phone:843-761-8800
Practice Address - Fax:843-761-8824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA2416Medicaid
SCPA2416Medicaid