Organization
ORTHO KICKZ OF THE CAROLINAS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RODERIC BAIN (OWNER)
(912) 963-7090
Entity
Organization
Contact information
Practice address
219 SCOTT ST, SUITE 177, BEAUFORT, SC 29902-5554
(912) 963-7090
(912) 355-5619
Mailing address
219 SCOTT ST, SUITE 177, BEAUFORT, SC 29902-5554
(912) 963-7090
(912) 355-5619
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
12/17/2014
Last updated
06/01/2016
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