MEDICARE: ANDERSON PROSTHETICS & ORTHOTICS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1154920395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDERSON PROSTHETICS & ORTHOTICS, LLC

Provider Business Mailing Address
First Line	:	307 W TREMONT AVE STE 200
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-4902
Country	:	US
Telephone Number	:	864-225-1683
Fax Number	:	864-231-7374

Provider Business Practice Location Address
First Line	:	307 W TREMONT AVE STE 200
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-4902
Country	:	US
Telephone Number	:	864-225-1683
Fax Number	:	864-231-7374

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MICAHEL CORCORAN
Credential	:	CPO
Telephone Number	:	301-585-5347

Provider Enumeration Date	:	10/20/2020
Last Update Date	:	03/30/2021

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