Provider Demographics
NPI:1245643212
Name:FALL PREVENTION ALLIANCE
Entity type:Organization
Organization Name:FALL PREVENTION ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MIKELL
Authorized Official - Last Name:LELAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-494-3744
Mailing Address - Street 1:1739 MAYBANK HWY
Mailing Address - Street 2:SUITE T-612
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-2103
Mailing Address - Country:US
Mailing Address - Phone:843-494-3744
Mailing Address - Fax:844-584-3469
Practice Address - Street 1:418 FOLLY RD
Practice Address - Street 2:SUITE A
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2625
Practice Address - Country:US
Practice Address - Phone:843-795-5362
Practice Address - Fax:844-584-3469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-08
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty