Provider Demographics
NPI:1780985911
Name:BROOKS PROSTHETICS AND ORTHOTICS
Entity type:Organization
Organization Name:BROOKS PROSTHETICS AND ORTHOTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GERI
Authorized Official - Middle Name:
Authorized Official - Last Name:LECKIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-282-5213
Mailing Address - Street 1:527 MILLS AVE STE 101B
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-5602
Mailing Address - Country:US
Mailing Address - Phone:864-282-5213
Mailing Address - Fax:864-282-5214
Practice Address - Street 1:527 MILLS AVE STE 101B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-5602
Practice Address - Country:US
Practice Address - Phone:864-282-5213
Practice Address - Fax:864-282-5214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE3401Medicaid