Provider Demographics
NPI:1821081159
Name:ADVANCED PROSTHETICS OF EASLEY, INC.
Entity Type:Organization
Organization Name:ADVANCED PROSTHETICS OF EASLEY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR. OF HR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-622-0900
Mailing Address - Street 1:1661 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-3791
Mailing Address - Country:US
Mailing Address - Phone:864-859-4709
Mailing Address - Fax:864-855-9331
Practice Address - Street 1:1661 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640
Practice Address - Country:US
Practice Address - Phone:864-859-4709
Practice Address - Fax:864-855-9331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE1361Medicaid
1258430001Medicare PIN