Provider Demographics
NPI:1629229612
Name:CAROLINA PROSTHETICS & ORTHOTICS INC.
Entity Type:Organization
Organization Name:CAROLINA PROSTHETICS & ORTHOTICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHETIST/ORTHOTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:MCCREA
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:864-653-4600
Mailing Address - Street 1:110 LINER DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-2310
Mailing Address - Country:US
Mailing Address - Phone:864-653-4300
Mailing Address - Fax:864-653-4600
Practice Address - Street 1:1011 TIGER BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-2915
Practice Address - Country:US
Practice Address - Phone:864-653-4300
Practice Address - Fax:864-653-4600
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINA PROSTHETICS & ORTHOTICS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-08
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5998790002Medicare NSC