Provider Demographics
NPI:1104018126
Name:PROSTHETIC CARE, INC
Entity Type:Organization
Organization Name:PROSTHETIC CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-493-8288
Mailing Address - Street 1:1009 GROVE RD
Mailing Address - Street 2:SUITE B1
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4600
Mailing Address - Country:US
Mailing Address - Phone:864-370-2010
Mailing Address - Fax:864-370-1611
Practice Address - Street 1:11 BRENDAN WAY
Practice Address - Street 2:SUITE 150
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3586
Practice Address - Country:US
Practice Address - Phone:864-234-9095
Practice Address - Fax:864-234-9092
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HANGER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-14
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE3340Medicaid
SCDE3340Medicaid