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NPI Code Detail

MEDICARE: CAROLINA ORTHOTICS AND PROSTHETICS LLC

MEDICARE: CAROLINA 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
1335E00000XProsthetic/Orthotic Supplier

General Provider Information

NPI Number : 1669893624
Entity Type Code : Organization
Provider Name (Legal Business Name) : CAROLINA ORTHOTICS AND PROSTHETICS LLC
Provider Business Mailing Address
First Line : 4975 LACROSS RD STE 314
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29406-6531
Country : US
Telephone Number : 843-577-9577
Fax Number : 843-577-9574
Provider Business Practice Location Address
First Line : 1321 ASHLEY RIVER RD
Second Line :
City : CHARLESTON
State : SC
Zip : 29407-5315
Country : US
Telephone Number : 843-377-0847
Fax Number : 843-377-0845
Authorized Official
Title or Position : COO
Name : DAVID VICK
Credential :
Telephone Number : 843-577-9577
Provider Enumeration Date : 12/18/2013
Last Update Date : 03/07/2022

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Directions to “CAROLINA ORTHOTICS AND PROSTHETICS LLC ” Practice Location

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