Healthcare Provider Details

I. General information

NPI: 1285890574
Provider Name (Legal Business Name): ANDERSON PROSTHETICS & ORTHOTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 ROPER MT RD SUITE G-2
GREENVILLE SC
29615-4242
US

IV. Provider business mailing address

1113 N FANT ST
ANDERSON SC
29621-4819
US

V. Phone/Fax

Practice location:
  • Phone: 864-676-0029
  • Fax: 864-676-0039
Mailing address:
  • Phone: 864-225-1683
  • Fax: 864-231-7374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberN/A
License Number StateSC

VIII. Authorized Official

Name: MR. MICHAEL CORCORAN
Title or Position: PRESIDENT/ CPO
Credential: CPO
Phone: 301-585-5347