Healthcare Provider Details

I. General information

NPI: 1235978677
Provider Name (Legal Business Name): TIERNEY ORTHOTICS AND PROSTHETICS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2024
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 YANCEYVILLE ST STE B
GREENSBORO NC
27405-6961
US

IV. Provider business mailing address

1345 WESTGATE CENTER DR STE B
WINSTON SALEM NC
27103-3041
US

V. Phone/Fax

Practice location:
  • Phone: 336-537-3901
  • Fax: 336-893-9537
Mailing address:
  • Phone: 336-546-7165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: GEOFFREY TIBBS
Title or Position: DIRECTOR OF CRANIAL
Credential: CO
Phone: 336-830-4762