Provider Demographics
NPI:1740794288
Name:PROSTHETIC & ORTHOTIC INSTITUTE INC.
Entity Type:Organization
Organization Name:PROSTHETIC & ORTHOTIC INSTITUTE INC.
Other - Org Name:PROSTHETIC & ORTHOTIC INSTITUTE, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:KELVIN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-980-5080
Mailing Address - Street 1:223 S. HERONG AVE.
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732
Mailing Address - Country:US
Mailing Address - Phone:803-980-5080
Mailing Address - Fax:
Practice Address - Street 1:10502 PARK RD STE 170
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-6490
Practice Address - Country:US
Practice Address - Phone:803-980-5080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROSTHETIC & ORTHOTIC INSTITUTE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-20
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies