Provider Demographics
NPI:1811140940
Name:ADVANCED ORTHOTICS AND PROSTHETICS
Entity type:Organization
Organization Name:ADVANCED ORTHOTICS AND PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/P5RESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIPE
Authorized Official - Middle Name:RAMON
Authorized Official - Last Name:CARTAYA
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:843-206-3777
Mailing Address - Street 1:316 79TH AVE N
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4304
Mailing Address - Country:US
Mailing Address - Phone:843-206-3777
Mailing Address - Fax:
Practice Address - Street 1:316 79TH AVE N
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4304
Practice Address - Country:US
Practice Address - Phone:843-206-3777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0154280001Medicare NSC