Healthcare Provider Details

I. General information

NPI: 1356917785
Provider Name (Legal Business Name): JP MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 PHYSICIANS DR STE 102
CHARLESTON SC
29414-5719
US

IV. Provider business mailing address

1012 PHYSICIANS DR STE 102
CHARLESTON SC
29414-5719
US

V. Phone/Fax

Practice location:
  • Phone: 843-473-7246
  • Fax: 843-279-4939
Mailing address:
  • Phone: 843-473-7246
  • Fax: 843-279-4939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JASON PERO
Title or Position: MEMBER/MANAGER
Credential:
Phone: 734-657-0926