Healthcare Provider Details

I. General information

NPI: 1184119976
Provider Name (Legal Business Name): ORTHOTIC & PROSTHETIC CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9241 UNIVERSITY BLVD STE B1
NORTH CHARLESTON SC
29406-9349
US

IV. Provider business mailing address

3611 5TH AVE N
SAINT PETERSBURG FL
33713-7503
US

V. Phone/Fax

Practice location:
  • Phone: 843-531-9990
  • Fax: 843-804-4811
Mailing address:
  • Phone: 727-327-3332
  • Fax:

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 TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA GELAZNIK
Title or Position: DIRECTOR OF FINANCE & OPERATIONS
Credential:
Phone: 727-498-1003