Organization
PALMETTO BRACE SHOP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES N DERRICK (OWNER PRESIDENT)
(803) 254-1632
Entity
Organization
Contact information
Practice address
1910 HAMPTON STREET, COLUMBIA, SC 29201
(803) 254-1632
(803) 254-0922
Mailing address
1910 HAMPTON STREET, COLUMBIA, SC 29201
(803) 254-1632
(803) 254-0922
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
540515
—
SC
Enumeration date
03/07/2006
Last updated
08/22/2020
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