Provider Demographics
NPI:1750640918
Name:AUGUSTA PROSTHETICS AND ORTHOTICS, INC
Entity Type:Organization
Organization Name:AUGUSTA PROSTHETICS AND ORTHOTICS, INC
Other - Org Name:AOPI ORTHOTICS AND PROSTHETICS, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY (TRIPP)
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:RICE
Authorized Official - Suffix:III
Authorized Official - Credentials:CERTIFIED PROSTHETIS
Authorized Official - Phone:706-830-3456
Mailing Address - Street 1:2068 WRIGHTSBORO ROAD
Mailing Address - Street 2:AOPI ORTHOTICS AND PROSTHETICS, INC
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904
Mailing Address - Country:US
Mailing Address - Phone:706-733-8878
Mailing Address - Fax:706-733-4434
Practice Address - Street 1:3020 SUNSET BLVD,
Practice Address - Street 2:SUITE 106
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169
Practice Address - Country:US
Practice Address - Phone:803-335-4240
Practice Address - Fax:803-658-0300
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AUGUSTA PROSTHETICS AND ORTHOI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA335E00000X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA244357156BMedicaid
SCDE1438Medicaid
1267170002Medicare NSC