Healthcare Provider Details

I. General information

NPI: 1992641419
Provider Name (Legal Business Name): TIERNEY ORTHOTICS AND PROSTHETICS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 GATEWOOD AVE
HIGH POINT NC
27262-4820
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 336-546-7165
  • Fax:
Mailing address:
  • Phone: 336-546-7165
  • Fax: 866-403-2483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA VESTAL TIERNEY
Title or Position: OWNER
Credential: BOCO
Phone: 336-749-8505