Healthcare Provider Details

I. General information

NPI: 1629321757
Provider Name (Legal Business Name): EZ & A, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2012
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4683 CABOL RD
SHARON SC
29742-6785
US

IV. Provider business mailing address

4683 CABLE ROAD
SHARON SC
29742
UM

V. Phone/Fax

Practice location:
  • Phone: 864-871-1144
  • Fax:
Mailing address:
  • Phone: 864-871-1144
  • Fax:

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: MISS LORRAINE GORE
Title or Position: OWNER
Credential:
Phone: 864-871-1144