Healthcare Provider Details

I. General information

NPI: 1821077306
Provider Name (Legal Business Name): LYONS PROSTHETICS & ORTHOTICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 WACCAMAW MEDICAL PARK DRIVE
CONWAY SC
29526
US

IV. Provider business mailing address

121 WACCAMAW MEDICAL PARK DRIVE
CONWAY SC
29526
US

V. Phone/Fax

Practice location:
  • Phone: 843-347-5800
  • Fax: 843-347-7469
Mailing address:
  • Phone: 843-347-5800
  • Fax: 843-347-7469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number026557921
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name: MR. ALEX LYONS
Title or Position: OWNER
Credential:
Phone: 843-347-7469