Provider Demographics
NPI:1790254274
Name:GREENWOOD ORTHOTICS, LLC
Entity Type:Organization
Organization Name:GREENWOOD ORTHOTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:W
Authorized Official - Last Name:NOVACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-682-8570
Mailing Address - Street 1:4360 CARRAWAY PL STE A
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-8522
Mailing Address - Country:US
Mailing Address - Phone:407-732-6381
Mailing Address - Fax:
Practice Address - Street 1:4360 CARRAWAY PL STE A
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-8522
Practice Address - Country:US
Practice Address - Phone:407-732-6381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies