Provider Demographics
NPI:1649425349
Name:ADVANCED PROSTHETICS, INC
Entity type:Organization
Organization Name:ADVANCED PROSTHETICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCGAHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-859-4709
Mailing Address - Street 1:400 SE MAIN ST STE E
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-2693
Mailing Address - Country:US
Mailing Address - Phone:864-963-8000
Mailing Address - Fax:864-963-5400
Practice Address - Street 1:400 SE MAIN ST STE E
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-2693
Practice Address - Country:US
Practice Address - Phone:864-963-8000
Practice Address - Fax:864-963-5400
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED PROSTHETICS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-21
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
SC19076335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE3403Medicaid
5472370002Medicare PIN