The Brace Shoppe Inc.

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

ORT0000000095 Issued in TN

Legal business name

THE BRACE SHOPPE INC.

Practice address

300 Wood Mist LN
Fountain Inn, SC 29644-9273

Phone

(304) 638-3128

Fax

(304) 638-3128

NPI assigned

Sep 13, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jackie Sue Ball, LCO

Title

President/Owner

Phone

(304) 638-3128

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• The Brace Shoppe, Inc Former legal business name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1189641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700006400000",
    "number": "1396930293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 WOOD MIST LN",
            "city": "FOUNTAIN INN",
            "state": "SC",
            "postal_code": "296449273",
            "telephone_number": "304-638-3128",
            "fax_number": "304-638-3128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 WOOD MIST LN",
            "city": "FOUNTAIN INN",
            "state": "SC",
            "postal_code": "296449273",
            "telephone_number": "304-638-3128",
            "fax_number": "304-638-3128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE BRACE SHOPPE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-13",
        "last_updated": "2023-11-15",
        "certification_date": "2023-11-15",
        "status": "A",
        "authorized_official_last_name": "BALL",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "304-638-3128",
        "authorized_official_credential": "LCO"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "TN",
            "license": "ORT0000000095",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "90012089",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810004179",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2609216",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Brace Shoppe, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Prosthetic/Orthotic Supplier in Fountain Inn, SC
• Providers in Fountain Inn, SC by specialty
• Prosthetic/Orthotic Supplier in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.