Provider Demographics
NPI:1154343887
Name:ORTHOPEDIC SERVICES, INC
Entity type:Organization
Organization Name:ORTHOPEDIC SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:VANDERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:864-885-0077
Mailing Address - Street 1:10 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4236
Mailing Address - Country:US
Mailing Address - Phone:864-885-0077
Mailing Address - Fax:864-885-0084
Practice Address - Street 1:10702A CLEMSON BLVD
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-4528
Practice Address - Country:US
Practice Address - Phone:864-233-7893
Practice Address - Fax:864-242-3247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDME309Medicaid
0154460003Medicare NSC