Organization
CHARLESTON ORTHOPEDIC APPLIANCES INC
Active
Other names
CHARLESTON ORTHPEDIC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CECIL A TANKERSLEY CO,BOCO,C-PED,RTO (PRESIDENT)
(304) 343-8994
Entity
Organization
Contact information
Practice address
1532 KANAWHA BLVD W, CHARLESTON, WV 25312-2533
(304) 343-8994
(304) 720-2078
Mailing address
1532 KANAWHA BLVD W, CHARLESTON, WV 25312-2533
(304) 343-8994
(304) 720-2078
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
NOT APPLICABLE
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000201174
BLUE CROSS & BLUE SHIELD
WV
05
—
0148049000
—
WV
05
—
2417067
—
OH
Enumeration date
07/10/2006
Last updated
07/29/2009
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