1811150451 NPI number — H. JOSEPH FOSTER III

Table of content: (NPI 1811150451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811150451 NPI number — H. JOSEPH FOSTER III

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
H. JOSEPH FOSTER III
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SUPERIOR ORTHOTICS AND PROSTHETICS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811150451
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 ROCHESTER HWY
Provider Second Line Business Mailing Address:
SUITE C2
Provider Business Mailing Address City Name:
SENECA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29672-2466
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-985-0808
Provider Business Mailing Address Fax Number:
864-985-0525

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
841 W NORTH 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SENECA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29678-2528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-888-4730
Provider Business Practice Location Address Fax Number:
864-888-4731
Provider Enumeration Date:
07/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
FOSTER
Authorized Official First Name:
HEYWARD
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
864-985-0808

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DME939 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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