NPIMap

Organization Active NPI

Harris Teeter LLC

Doing business as Harris Teeter #429

  • Community/Retail Pharmacy
  • Beaufort, SC
National Provider Identifier
1801655725
Registry record updated Mar 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
HARRIS TEETER LLC
Doing business as
Harris Teeter #429
Practice address
163 Sea Island Pkwy
Beaufort, SC 29907-1504
Phone
(854) 846-8330
Fax
(843) 593-9219
NPI assigned
Mar 14, 2024
Last updated
Mar 14, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2024

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

Authorized official

Name
Lysette Seilhamer
Title
Manager of Licensing
Phone
(515) 762-1090

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

163 Sea Island Pkwy
Beaufort, SC 29907-1504

Mailing address

PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1090

Other names 1

  • Harris Teeter #429 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110307000698 SC Part B Supplier - Mass Immunization (Roster Biller Only) 9234255217 20 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Summerville, SC; Rock Hill, SC; Charleston, SC; Mt Pleasant, SC; Mount Pleasant, SC; Indian Land, SC; Hilton Head Island, SC; Hilton Head, SC…
O20241216000429 SC DME Supplier - Pharmacy 9234255217 Practice locations: Beaufort, SC

Other NPIs on the same Medicare enrollment 20

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 20

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D2305207Harris Teeter #097-429163 Sea Island Parkway, Beaufort, SC 29907Certificate of waiverMay 27, 2028

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Harris Teeter LLC163 Sea Island Pkwy, Beaufort, SC 29907-1504(854) 846-8330 Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Canes and/or Crutches|Walkers|Ostomy Supplies|Urological Supplies|Enteral Equipment and/or Supplies|Nebulizer Equipment and/or Supplies|Oxy… Accepts assignmentParticipating since Mar 22, 2011

National Provider Directory

National Provider Directory
Tax ID family
Harris Teeter LLC208 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 17

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 17

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1710374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710374400000",
    "number": "1801655725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 842772",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022842772",
            "telephone_number": "513-762-1090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "163 SEA ISLAND PKWY",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299071504",
            "telephone_number": "854-846-8330",
            "fax_number": "843-593-9219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARRIS TEETER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-14",
        "last_updated": "2024-03-14",
        "certification_date": "2024-03-14",
        "status": "A",
        "authorized_official_last_name": "SEILHAMER",
        "authorized_official_first_name": "LYSETTE",
        "authorized_official_title_or_position": "MANAGER OF LICENSING",
        "authorized_official_telephone_number": "515-762-1090"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harris Teeter #429",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Beaufort, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.