The Breast Place LLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

DO910 Issued in SC

Legal business name

THE BREAST PLACE LLC

Doing business as

The Breast Place

Practice address

4975 Lacross Rd Ste 110
North Charleston, SC 29406

Phone

(843) 797-1941

Fax

(843) 574-1698

NPI assigned

Sep 29, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Jennifer Beatty, DONPI 1952387979

Title

Owner

Phone

(843) 797-1941

Specialties & licenses 1

Addresses

Other names 1

• THE BREAST PLACE Doing business as

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jennifer F. Beatty, D.O.

  • Surgery Physician
  • Greenville, SC
  • NPI 1952387979
  Medicare reassignment NPD Authorized official
• Emily C Lever, PA-C

  • Physician Assistant
  • North Charleston, SC
  • NPI 1124610936
  Medicare reassignment
• Megan Elizabeth Keogh, PA-C

  • Physician Assistant
  • Cheektowaga, NY
  • NPI 1841881505

  SC

  Medicare reassignment

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

{
    "created_epoch": "1317254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561420800000",
    "number": "1629352398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4975 LACROSS RD STE 110",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294066531",
            "telephone_number": "843-797-1941",
            "fax_number": "843-574-1698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4975 LACROSS RD STE 110",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "29406",
            "telephone_number": "843-797-1941",
            "fax_number": "843-574-1698"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2910 Tricom St",
            "address_2": "SUITE 201",
            "address_purpose": "LOCATION",
            "city": "North Charleston",
            "state": "SC",
            "postal_code": "294069350",
            "country_code": "US",
            "telephone_number": "843-797-1941",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "THE BREAST PLACE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-29",
        "last_updated": "2019-06-25",
        "status": "A",
        "authorized_official_last_name": "BEATTY",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-797-1941",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "SC",
            "license": "DO910",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "THE BREAST PLACE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michael Thackery
• Katelin Rose Thames, MA, LPC, LMHC
• Angela Christine Tharnish, D.C.
• Allyson J Thatcher, MD
• The Affective Collective LLC
• The Key Services , LLC
• The Lab Taxii LLC
• The Mary Jenkins Center for Behavioral Health LLC
• The PT Blueprint, LLC
• The Wellness Collective Integrated Services LLC

• Surgery Physician in North Charleston, SC
• Providers in North Charleston, SC by specialty
• Surgery Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2019; 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.