Basic Information
| Provider Information | |||||||||
| NPI: | 1861057333 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORTHOSC LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 VILLAGE CENTER BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | MYRTLE BEACH | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295796706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433533460 | ||||||||
| FaxNumber: | 8433533461 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 VILLAGE CENTER BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | MYRTLE BEACH | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295796706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434914937 | ||||||||
| FaxNumber: | 8433533461 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2019 | ||||||||
| LastUpdateDate: | 05/09/2019 | ||||||||
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| AuthorizedOfficialLastName: | EDELEN | ||||||||
| AuthorizedOfficialFirstName: | JENIFER | ||||||||
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| AuthorizedOfficialTitleorPosition: | REVENUE CYCLE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8432136149 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.