Healthcare Provider Details

I. General information

NPI: 1801077367
Provider Name (Legal Business Name): ALEXANDER PROSTHETICS & ORTHOTICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 SPRING AVE NE
WISE VA
24293-5702
US

IV. Provider business mailing address

716 SPRING AVE NE P. O. BOX 3425
WISE VA
24293-5702
US

V. Phone/Fax

Practice location:
  • Phone: 276-328-6200
  • Fax: 423-343-5654
Mailing address:
  • Phone: 276-328-6200
  • Fax: 423-343-5654

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