Provider Demographics
NPI:1912898891
Name:OWENS CAROLINA ORTHOTIC & PROSTHETIC NETWORK, INC.
Entity type:Organization
Organization Name:OWENS CAROLINA ORTHOTIC & PROSTHETIC NETWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:MHCA
Authorized Official - Phone:704-332-5143
Mailing Address - Street 1:998 RIVERWALK PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-0117
Mailing Address - Country:US
Mailing Address - Phone:704-332-5143
Mailing Address - Fax:
Practice Address - Street 1:998 RIVERWALK PKWY STE 205
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-0117
Practice Address - Country:US
Practice Address - Phone:704-332-5143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies