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		SC

Other Identifiers

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

General Provider Information

NPI Number	:	1245288745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDERSON PROSTHETICS & ORTHOTICS, LLC

Provider Business Mailing Address
First Line	:	1113 N FANT ST
Second Line	:
City	:	ANDERSON
State	:	SC
Zip	:	29621-4819
Country	:	US
Telephone Number	:	864-225-1683
Fax Number	:	864-231-7374

Provider Business Practice Location Address
First Line	:	1113 N FANT ST
Second Line	:
City	:	ANDERSON
State	:	SC
Zip	:	29621-4819
Country	:	US
Telephone Number	:	864-225-1683
Fax Number	:	864-231-7374

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MICHAEL CORCORAN JR.
Credential	:	CPO
Telephone Number	:	301-585-5347

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	07/21/2022

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