MEDICARE: WILLIAM COLLINS VANN CPO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1744P3200X	Prosthetics Case Management

General Provider Information

NPI Number	:	1528259736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM COLLINS VANN CPO

Provider Business Mailing Address
First Line	:	4739 HIGHWAY 17 BYP S
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-6682
Country	:	US
Telephone Number	:	843-293-4904
Fax Number	:	843-293-2461

Provider Business Practice Location Address
First Line	:	4739 HIGHWAY 17 BYP S
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-6682
Country	:	US
Telephone Number	:	843-293-4904
Fax Number	:	843-293-2461

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	08/05/2007

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