Healthcare Provider Details

I. General information

NPI: 1851645949
Provider Name (Legal Business Name): COMPLETE PROSTHETICS & ORTHOTICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2012
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 5TH ST N
COLUMBUS MS
39705-2211
US

IV. Provider business mailing address

2221 5TH ST N
COLUMBUS MS
39705-2211
US

V. Phone/Fax

Practice location:
  • Phone: 662-844-2363
  • Fax: 662-844-2624
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES GREGORY QUINN
Title or Position: OWNER
Credential: RPH
Phone: 662-844-2363