Provider Demographics
NPI:1306418892
Name:MEDICAL CENTER ORTHOTICS AND PROSTHETICS, LLC
Entity Type:Organization
Organization Name:MEDICAL CENTER ORTHOTICS AND PROSTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:CORCORAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:301-585-5347
Mailing Address - Street 1:2421 LINDEN LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1230
Mailing Address - Country:US
Mailing Address - Phone:301-585-5347
Mailing Address - Fax:
Practice Address - Street 1:440 ROPER MOUNTAIN RD STE G2
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4235
Practice Address - Country:US
Practice Address - Phone:864-646-0029
Practice Address - Fax:864-646-0039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier