Provider Demographics
NPI:1114234135
Name:PALMETTO PROSTHETICS AND ORTHOTICS, INC.
Entity Type:Organization
Organization Name:PALMETTO PROSTHETICS AND ORTHOTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOYD
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:843-673-9222
Mailing Address - Street 1:451 W CHEVES ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4446
Mailing Address - Country:US
Mailing Address - Phone:843-673-9222
Mailing Address - Fax:843-673-0333
Practice Address - Street 1:108 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-3306
Practice Address - Country:US
Practice Address - Phone:843-841-1100
Practice Address - Fax:843-841-1109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0844090004Medicare NSC