Provider Demographics
NPI:1902981269
Name:SOUTH CAROLINA INSTITUTE OF PROSTHETICS,
Entity type:Organization
Organization Name:SOUTH CAROLINA INSTITUTE OF PROSTHETICS,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BRANCH MANAGER / AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:E
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:843-208-2100
Mailing Address - Street 1:300 NEW RIVER PKWY
Mailing Address - Street 2:SUITE 12
Mailing Address - City:HARDEEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29927-4450
Mailing Address - Country:US
Mailing Address - Phone:843-208-2100
Mailing Address - Fax:843-208-2101
Practice Address - Street 1:300 NEW RIVER PKWY
Practice Address - Street 2:SUITE 12
Practice Address - City:HARDEEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29927-4450
Practice Address - Country:US
Practice Address - Phone:843-208-2100
Practice Address - Fax:843-208-2101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2693CP332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2470Medicaid
SCDE2470Medicaid