Provider Demographics
NPI:1093774416
Name:PROSTHETIC & ORTHOTIC INSTITUTE INC
Entity Type:Organization
Organization Name:PROSTHETIC & ORTHOTIC INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:KELVIN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-980-5080
Mailing Address - Street 1:223 S. HERLONG AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1089
Mailing Address - Country:US
Mailing Address - Phone:803-980-5080
Mailing Address - Fax:803-980-5083
Practice Address - Street 1:223 S. HERLONG AVE
Practice Address - Street 2:STE 110
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1089
Practice Address - Country:US
Practice Address - Phone:803-980-5080
Practice Address - Fax:803-980-5083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE1399Medicaid
NC7704987Medicaid
1198280003Medicare ID - Type Unspecified