Provider Demographics
NPI:1871950543
Name:BIOLOGIC P AND O, LLC
Entity type:Organization
Organization Name:BIOLOGIC P AND O, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CAREY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BUNCH
Authorized Official - Suffix:
Authorized Official - Credentials:CPO/L
Authorized Official - Phone:803-534-6567
Mailing Address - Street 1:2664 SAINT MATTHEWS RD STE B
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-1344
Mailing Address - Country:US
Mailing Address - Phone:803-534-6567
Mailing Address - Fax:803-937-6566
Practice Address - Street 1:2664 SAINT MATTHEWS RD STE B
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-1344
Practice Address - Country:US
Practice Address - Phone:803-534-6567
Practice Address - Fax:803-937-6566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE3716Medicaid
SC7529830001Medicare PIN