Healthcare Provider Details

I. General information

NPI: 1750388013
Provider Name (Legal Business Name): FAITH PROSTHEITC-ORTHOTIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 W ALEXANDER AVE STE I
GREENWOOD SC
29646-4078
US

IV. Provider business mailing address

303 W ALEXANDER AVE STE I
GREENWOOD SC
29646-4078
US

V. Phone/Fax

Practice location:
  • Phone: 864-229-3299
  • Fax: 864-229-4491
Mailing address:
  • Phone: 864-229-3299
  • Fax: 864-229-4491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JIM B PRICE JR.
Title or Position: PRESIDENT
Credential: PH.D, C.P.O.
Phone: 704-782-0908