Provider Demographics
NPI:1376891119
Name:SUMTER PROSTHETICS & ORTHOTICS LLC
Entity Type:Organization
Organization Name:SUMTER PROSTHETICS & ORTHOTICS LLC
Other - Org Name:CAROLINA ORTHOTICS AND PROSTHETICS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:C
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:HOOPER
Authorized Official - Suffix:JR
Authorized Official - Credentials:CPO
Authorized Official - Phone:843-577-9577
Mailing Address - Street 1:3801 W MONTAGUE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-5938
Mailing Address - Country:US
Mailing Address - Phone:843-577-9577
Mailing Address - Fax:843-718-1438
Practice Address - Street 1:259 A BROAD ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4146
Practice Address - Country:US
Practice Address - Phone:803-883-4356
Practice Address - Fax:803-883-4386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC6715560001Medicare NSC