Palmetto Sleep Lab LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

PALMETTO SLEEP LAB LLC

Practice address

1207 Lakeside Dr Unit B
Conway, SC 29526-4026

Phone

(843) 234-4900

Fax

(843) 234-4901

NPI assigned

Aug 5, 2011

Last updated

Jun 17, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jerry Milton Capell

Title

Owner

Phone

(843) 444-0800

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Palmetto Sleep Lab LLC

  • Clinical Medical Laboratory
  • Murrells Inlet, SC
  • NPI 1497952758

  9537154836

  Same PAC ID
• Palmetto Sleep Lab LLC

  • Clinical Medical Laboratory
  • Myrtle Beach, SC
  • NPI 1639284136

  9537154836

  Same PAC ID
• Palmetto Sleep Lab LLC

  • Clinical Medical Laboratory
  • Little River, SC
  • NPI 1861632523

  9537154836

  Same PAC ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1312502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655424000000",
    "number": "1588943757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1226",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295781226",
            "telephone_number": "843-444-0800",
            "fax_number": "843-444-0881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1207 LAKESIDE DR UNIT B",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295264026",
            "telephone_number": "843-234-4900",
            "fax_number": "843-234-4901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMETTO SLEEP LAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-05",
        "last_updated": "2022-06-17",
        "certification_date": "2022-06-17",
        "status": "A",
        "authorized_official_last_name": "CAPELL",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "MILTON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-444-0800"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "1234DD",
            "identifier": "PL0073",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Miriam Iskandar Overholser, PA-C
• Ovp Health Care, Inc.
• Kimberley Page, MS, RD, LDN
• Samantha E Paggeot, BA, MS, LPC
• Palmetto Pediatrics of Conway
• Tianrun Pan, MD
• Sona Panchal
• Justin Pandoo, MD
• Catherine Panos, LPC-I, CAC-P
• Nicole Marie Pantis, RN

• Clinical Medical Laboratory in Conway, SC
• Providers in Conway, SC by specialty
• Clinical Medical Laboratory in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.