Healthcare Provider Details

I. General information

NPI: 1376891119
Provider Name (Legal Business Name): SUMTER PROSTHETICS & ORTHOTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 06/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 A BROAD ST
SUMTER SC
29150-4146
US

IV. Provider business mailing address

3801 W MONTAGUE AVE STE 100
N CHARLESTON SC
29418-5938
US

V. Phone/Fax

Practice location:
  • Phone: 803-883-4356
  • Fax: 803-883-4386
Mailing address:
  • Phone: 843-577-9577
  • Fax: 843-718-1438

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: C RALPH HOOPER JR.
Title or Position: CEO
Credential: CPO
Phone: 843-577-9577