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NPI Code Detail

MEDICARE: PROSTHETIC CARE OF ANDERSON, LLC

MEDICARE: PROSTHETIC CARE OF ANDERSON, LLC
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
1335E00000XProsthetic/Orthotic Supplier90GA

General Provider Information

NPI Number : 1750679064
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROSTHETIC CARE OF ANDERSON, LLC
Provider Business Mailing Address
First Line : 18022 COWAN
Second Line : SUITE 285
City : IRVINE
State : CA
Zip : 92614-6806
Country : US
Telephone Number : 949-863-1951
Fax Number : 949-863-1419
Provider Business Practice Location Address
First Line : 615 COOK ST
Second Line :
City : ROYSTON
State : GA
Zip : 30662-3933
Country : US
Telephone Number : 706-245-6212
Fax Number : 706-245-6262
Authorized Official
Title or Position : CEO
Name : MR. MICHAEL E HAMONTREE
Credential :
Telephone Number : 949-863-1951
Provider Enumeration Date : 07/20/2011
Last Update Date : 07/20/2011

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