MEDICARE: TIERNEY ORTHOTICS AND PROSTHETICS INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1235978677
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIERNEY ORTHOTICS AND PROSTHETICS INC.

Provider Business Mailing Address
First Line	:	1345 WESTGATE CENTER DR STE B
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-3041
Country	:	US
Telephone Number	:	336-546-7165
Fax Number	:

Provider Business Practice Location Address
First Line	:	1409 YANCEYVILLE ST STE B
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27405-6961
Country	:	US
Telephone Number	:	336-537-3901
Fax Number	:	336-893-9537

Authorized Official
Title or Position	:	DIRECTOR OF CRANIAL
Name	:	GEOFFREY TIBBS
Credential	:	CO
Telephone Number	:	336-830-4762

Provider Enumeration Date	:	05/24/2024
Last Update Date	:	01/07/2026

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