Provider Demographics
NPI:1922472182
Name:LOWCOUNTRY ORTHOTICS AND PROSTHETICS INC
Entity Type:Organization
Organization Name:LOWCOUNTRY ORTHOTICS AND PROSTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:AZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HASAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-208-3334
Mailing Address - Street 1:300 NEW RIVER PKWY
Mailing Address - Street 2:SUITE 12
Mailing Address - City:HARDEEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29927-4450
Mailing Address - Country:US
Mailing Address - Phone:843-208-3334
Mailing Address - Fax:843-208-3335
Practice Address - Street 1:300 NEW RIVER PKWY
Practice Address - Street 2:SUITE 12
Practice Address - City:HARDEEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29927-4450
Practice Address - Country:US
Practice Address - Phone:843-208-3334
Practice Address - Fax:843-208-3335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-25
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
7492010001Medicare NSC