Active NPI
Palmetto Sleep Lab LLC
- Clinical Medical Laboratory
- Myrtle Beach, SC
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Medical Laboratory
- Legal business name
- PALMETTO SLEEP LAB LLC
- Practice address
- 1705 N Oak St
Suite 8
Myrtle Beach, SC 29577-3580 - Phone
- (843) 444-0800
- NPI assigned
- Aug 21, 2006
- Organization subpart
- No
NPPES NPI Registry
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
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | Primary |
Addresses
Primary practice location
1705 N Oak St
Suite 8
Myrtle Beach, SC 29577-3580
Mailing address
PO Box 1226
Myrtle Beach, SC 29578-1226
Phone (843) 444-0800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PL0073 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040416000690 | SC | Part B Supplier - Independent Diagnostic Testing Facility (Idtf) | 9537154836 | Practice locations: Myrtle Beach, SC |
Other NPIs with the same Medicare PAC ID 3
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
National Provider Directory
National Provider Directory- Tax ID family
- Palmetto Sleep Lab LLC
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Clinical Medical Laboratory
- Murrells Inlet, SC
- NPI 1497952758
-
- Clinical Medical Laboratory
- Little River, SC
- NPI 1861632523
Locations
1087 Redi Mix Rd
Unit 4
Little River, SC 29566
Phone (843) 390-5122
4959 Highway 17
Unit A
Murrells Inlt, SC 29576
Phone (843) 652-0111
1705 N Oak St
Ste 8
Myrtle Beach, SC 29577
Phone (843) 444-0800
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Neurology Physician
- Myrtle Beach, SC
- NPI 1821057779
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156118400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1559001600000",
"number": "1639284136",
"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": "843-357-1471"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1705 N OAK ST",
"address_2": "SUITE 8",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295773580",
"telephone_number": "843-444-0800"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PALMETTO SLEEP LAB LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-21",
"last_updated": "2019-05-28",
"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": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PL0073",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Myrtle Beach, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 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.