Provider Demographics
NPI:1154920395
Name:ANDERSON PROSTHETICS & ORTHOTICS, LLC
Entity type:Organization
Organization Name:ANDERSON PROSTHETICS & ORTHOTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICAHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CORCORAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:301-585-5347
Mailing Address - Street 1:307 W TREMONT AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4902
Mailing Address - Country:US
Mailing Address - Phone:864-225-1683
Mailing Address - Fax:864-231-7374
Practice Address - Street 1:307 W TREMONT AVE STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4902
Practice Address - Country:US
Practice Address - Phone:864-225-1683
Practice Address - Fax:864-231-7374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-20
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier