Organization
CERTIFIED PEDORTHIC ORTHOTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH CANTWELL BOC,ABC PROSTHETIST (PRESIDENT)
(803) 779-0550
Entity
Organization
Contact information
Practice address
1901 BLANDING ST, COLUMBIA, SC 29201-3519
(803) 779-0550
(803) 779-4606
Mailing address
1901 BLANDING ST, COLUMBIA, SC 29201-3519
(803) 779-0550
(803) 779-4606
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
001666
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DME592
—
SC
Enumeration date
11/15/2005
Last updated
08/22/2020
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