Provider Demographics
NPI:1578510475
Name:CAPITAL PROSTHETICS & ORTHOTICS, INC.
Entity Type:Organization
Organization Name:CAPITAL PROSTHETICS & ORTHOTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:C
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:HOOPER JR
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:843-577-9577
Mailing Address - Street 1:3465 W MONTAGUE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-5938
Mailing Address - Country:US
Mailing Address - Phone:843-577-9577
Mailing Address - Fax:843-577-9574
Practice Address - Street 1:1455 HARDEN STREET EXT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-1755
Practice Address - Country:US
Practice Address - Phone:843-577-9577
Practice Address - Fax:843-577-9574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC557169Medicaid
SC557169Medicaid