Provider Demographics
NPI:1659763704
Name:CHARLESTON BRACING, LLC
Entity Type:Organization
Organization Name:CHARLESTON BRACING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:HIGHSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-410-9815
Mailing Address - Street 1:9313 MEDICAL PLAZA DR STE 303
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9197
Mailing Address - Country:US
Mailing Address - Phone:843-410-9815
Mailing Address - Fax:
Practice Address - Street 1:9313 MEDICAL PLAZA DR STE 303
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9197
Practice Address - Country:US
Practice Address - Phone:843-410-9815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-26
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier