MEDICARE: GREENVILLE ORTHOTICS AND PROSTHETICS, 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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7749060001	OTHER	SC	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174544704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENVILLE ORTHOTICS AND PROSTHETICS, LLC

Provider Business Mailing Address
First Line	:	3611 5TH AVE N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33713-7503
Country	:	US
Telephone Number	:	727-327-3332
Fax Number	:	727-327-7304

Provider Business Practice Location Address
First Line	:	10 EDGEWOOD DR
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29605-4236
Country	:	US
Telephone Number	:	864-552-1840
Fax Number	:	864-552-1841

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	PAUL CHRISTOPHER WEOTT
Credential	:	LPO/CPO
Telephone Number	:	727-327-3332

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	06/05/2026

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Directions to “GREENVILLE ORTHOTICS AND PROSTHETICS, LLC ” Practice Location

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