Organization
COASTAL PROSTHETIC & ORTHOTIC LABORATORY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM C VANN CPO (PRESIDENT)
(843) 651-8570
Entity
Organization
Contact information
Practice address
11871 PLAZA DRIVE, SUITE 6, MURRELLS INLET, SC 29576-9351
(843) 651-8570
(843) 651-2461
Mailing address
11871 PLAZA DRIVE, SUITE 6, MURRELLS INLET, SC 29576-9351
(843) 651-8570
(843) 651-2461
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
026218673
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
557506
—
SC
Enumeration date
11/03/2005
Last updated
12/28/2010
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