1750640918 NPI number — AUGUSTA PROSTHETICS AND ORTHOTICS, INC

Table of content: (NPI 1750640918)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750640918 NPI number — AUGUSTA PROSTHETICS AND ORTHOTICS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUGUSTA PROSTHETICS AND ORTHOTICS, INC
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:
Provider Other Organization Name Type Code:
6
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:
1750640918
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2068 WRIGHTSBORO ROAD
Provider Second Line Business Mailing Address:
AOPI ORTHOTICS AND PROSTHETICS, INC
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-733-8878
Provider Business Mailing Address Fax Number:
706-733-4434

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3020 SUNSET BLVD,
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
WEST COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29169
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-335-4240
Provider Business Practice Location Address Fax Number:
803-658-0300
Provider Enumeration Date:
05/09/2012

Additional Information

Authorized Official

Authorized Official Last Name:
RICE
Authorized Official First Name:
ROY (TRIPP)
Authorized Official Middle Name:
RAY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
706-830-3456

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 244357156B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: DE1438 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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