Provider Demographics
NPI:1750679064
Name:PROSTHETIC CARE OF ANDERSON, LLC
Entity Type:Organization
Organization Name:PROSTHETIC CARE OF ANDERSON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:HAMONTREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-863-1951
Mailing Address - Street 1:18022 COWAN
Mailing Address - Street 2:SUITE 285
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-6806
Mailing Address - Country:US
Mailing Address - Phone:949-863-1951
Mailing Address - Fax:949-863-1419
Practice Address - Street 1:615 COOK ST
Practice Address - Street 2:
Practice Address - City:ROYSTON
Practice Address - State:GA
Practice Address - Zip Code:30662-3933
Practice Address - Country:US
Practice Address - Phone:706-245-6212
Practice Address - Fax:706-245-6262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA90335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier