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General NPI Number Information
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NPI Number | 1174544704
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Entity Type | Organization
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Legal Business Name | GREENVILLE ORTHOTICS AND PROSTHETICS, LLC
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 10 EDGEWOOD DR
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City | GREENVILLE
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State | SC
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Zip | 29605-4236
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Country | US
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Telephone | 864-552-1840
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Fax | 864-552-1841
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Provider Business Mailing Address
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Address Line | 10 EDGEWOOD DR
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City | GREENVILLE
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State | SC
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Zip | 29605-4236
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Country | US
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Telephone | 864-552-1840
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Fax | 864-552-1841
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Authorized Official
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Title or Position | PARTNER
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Name | MR. CLARENCE RALPH HOOPER II
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Credential | C.P.O.
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Telephone | 864-552-1840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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