Healthcare Provider Details

I. General information

NPI: 1174544704
Provider Name (Legal Business Name): GREENVILLE ORTHOTICS AND PROSTHETICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 EDGEWOOD DR
GREENVILLE SC
29605-4236
US

IV. Provider business mailing address

10 EDGEWOOD DR
GREENVILLE SC
29605-4236
US

V. Phone/Fax

Practice location:
  • Phone: 864-552-1840
  • Fax: 864-552-1841
Mailing address:
  • Phone: 864-552-1840
  • Fax: 864-552-1841

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. CLARENCE RALPH HOOPER II
Title or Position: PARTNER
Credential: C.P.O.
Phone: 864-552-1840