Healthcare Provider Details

I. General information

NPI: 1144690504
Provider Name (Legal Business Name): APPALACHIAN PROSTHETIC & ORTHOTIC SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2015
Last Update Date: 09/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 PARK AVE NW
NORTON VA
24273-1923
US

IV. Provider business mailing address

3551 E STONE DR
KINGSPORT TN
37660-7115
US

V. Phone/Fax

Practice location:
  • Phone: 276-328-6200
  • Fax: 423-288-5227
Mailing address:
  • Phone: 423-288-8599
  • Fax: 423-288-5227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberORT0000000096
License Number StateTN

VIII. Authorized Official

Name: SHARON E WILLIAMS
Title or Position: PRESIDENT/SECRETARY
Credential: CO, BOCO, CPED
Phone: 423-288-8599