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Organization

ACTIVE MOBILITY UPSTATE LLC

Active
Other names
Carolina Orthotics and Prosthetics LLC
Organization subpart
No

Provider details

NPI number
Authorized official
MR. CLARENCE R HOOPER JR. CPO (PRESIDENT)
(843) 577-9577
Entity
Organization

Contact information

Practice address
115 GARNER ROAD, SPARTANBURG, SC 29303
(864) 541-0028
(864) 541-0027
Mailing address
3801 W. MONTAGUE AVE, SUITE 100, N CHARLESTON, SC 29418-5938
(843) 577-9577
(843) 718-1438

Taxonomy

Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
042523929
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
DE3088
SC
Enumeration date
09/25/2007
Last updated
06/26/2017
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