Provider Demographics
NPI:1417202821
Name:ADVANCED PROSTHETICS, INC
Entity Type:Organization
Organization Name:ADVANCED PROSTHETICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR. OF HR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-622-0900
Mailing Address - Street 1:720 GRACERN RD STE 115
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-7658
Mailing Address - Country:US
Mailing Address - Phone:803-509-6256
Mailing Address - Fax:803-509-6254
Practice Address - Street 1:720 GRACERN RD STE 115
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-7658
Practice Address - Country:US
Practice Address - Phone:803-509-6256
Practice Address - Fax:803-509-6254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-23
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
SC335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE3529Medicaid
SCDE3529Medicaid