Provider Demographics
NPI:1083632020
Name:ADVANCED PROSTHETICS OF SENECA, INC.
Entity Type:Organization
Organization Name:ADVANCED PROSTHETICS OF SENECA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR. OF HR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-622-0900
Mailing Address - Street 1:108 KEOWEE SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29672-6741
Mailing Address - Country:US
Mailing Address - Phone:864-886-8952
Mailing Address - Fax:864-886-8954
Practice Address - Street 1:108 KEOWEE SCHOOL RD
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-6741
Practice Address - Country:US
Practice Address - Phone:864-886-8952
Practice Address - Fax:864-886-8954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BC3200X
SC335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2799Medicaid
SC57528000001Medicare PIN