BERKELEY PROSTHETIC LABORATORY LLC (NPI# 1548660053) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548660053 |
| Entity Type | Organization |
| Organization Name | BERKELEY PROSTHETIC LABORATORY LLC |
| Practice Address |
216 Carolina Ave Moncks Corner SC 29461-3785 |
| Practice Telephone | 8437616411 |
| Practice Fax Number | 8437191189 |
| Mailing Telephone | 8437616411 |
| Mailing Fax Number | 8437191189 |
| Enumeration Date | 2014-09-03 |
| Last Update Date | 2014-09-03 |
| Authorized Official Name | MR. ERIC BRANDON ROBERTS (LAB MANAGER) |
| Authorized Official Telephone | 8437616411 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 292200000X | Dental Laboratory | 555 | SC | Laboratories |
| Street Address |
216 CAROLINA AVE |
| City | MONCKS CORNER |
| State | SC |
| Zip Code | 29461-3785 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982267605 | Berkeley Citizens Inc | Early Intervention Provider Agency | P0 Drawer 429 1301 Old Hwy 52 South, Moncks Corner, SC 29461 | 2019-04-18 |
| 1376015222 | Anthony Johnson | Counselor | 306 Airport Drive, Moncks Corner, SC 29461 | 2018-12-17 |
| 1598243719 | Jana Matthews Chinners | Family Medicine | 2061 Us-52, Moncks Corner, SC 29461 | 2018-07-31 |
| 1285151225 | Nathan Andrew Bostrom | Occupational Therapist | 118 Carolina Avenue, Moncks Corner, SC 29461 | 2017-08-29 |
| 1942730528 | Martina Snider | Specialist | 393 Corner Square Plaza, Moncks Corner, SC 29461 | 2017-06-15 |
| 1104355502 | Mary Elizabeth Perdue | Counselor | 306 Airport Dr., Moncks Corner, SC 29461 | 2017-06-08 |
| 1619390481 | Berkeley Citizens, Inc. | Public Health or Welfare | 1301 Old Hwy. 52 South, Moncks Corner, SC 29461 | 2014-01-29 |
| 1326384082 | Amanda Trueworthy | Counselor | 3156 F South Live Oak Drive, Moncks Corner, SC 29461 | 2012-12-27 |
| 1790040202 | Melanie Mcendree | Community Health Worker | 105 Lobolly Dr., Moncks Corner, SC 29461 | 2012-07-10 |
| 1891093845 | Leslie Erin Blackmon Stelling | Pharmacist | 110 South Highway 52, Moncks Corner, SC 29461 | 2011-02-28 |
| Find all providers in zip 29461 | ||||
| Taxonomy Code | 292200000X |
| Grouping | Laboratories |
| Classification | Dental Laboratory |
| A commercial laboratory specializing in the construction of dental appliances that conform to a dentist’s specifications including the construction of dentures (complete or partial), orthodontic appliances, bridgework, crowns, and inlays. |
| Notes: Source: Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 1245. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306026471 | 3di Diagnostic Oral Facial Imaging | Dental Laboratory | 1203 Two Island Ct, Suite 103b, Mt Pleasant, SC 29466-7405 | 2007-11-06 |
| City | MONCKS CORNER |
| Zip Code | 29461 |
Please comment or provide details below to improve the information on BERKELEY PROSTHETIC LABORATORY LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.