Organization
SOUTH COAST ORTHOPEDIC TECHNOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY SCOTT PENNEY CPO (PRESIDENT)
(508) 998-7268
Entity
Organization
Contact information
Practice address
535 FAUNCE CORNER RD, SUITE 201, N DARTMOUTH, MA 02747-1242
(508) 998-7268
(508) 998-7267
Mailing address
535 FAUNCE CORNER RD, SUITE 201, N DARTMOUTH, MA 02747-1242
(508) 998-7268
(508) 998-7267
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1528866
—
MA
01
—
401154
BLUE CROSS BLUE SHIELD
MA
01
—
811333
TUFTS
MA
Enumeration date
09/25/2007
Last updated
03/05/2010
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