Active Mobility Upstate LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

042523929 Issued in SC

Legal business name

ACTIVE MOBILITY UPSTATE LLC

Doing business as

Carolina Orthotics and Prosthetics LLC

Practice address

115 Garner Road
Spartanburg, SC 29303

Phone

(864) 541-0028

Fax

(864) 541-0027

NPI assigned

Sep 25, 2007

Last updated

Jun 26, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Clarence R Hooper Jr., CPO

Title

President

Phone

(843) 577-9577

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Carolina Orthotics and Prosthetics LLC Doing business as

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

{
    "created_epoch": "1190678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1498435200000",
    "number": "1871780742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 W. MONTAGUE AVE",
            "address_2": "SUITE 100",
            "city": "N CHARLESTON",
            "state": "SC",
            "postal_code": "294185938",
            "telephone_number": "843-577-9577",
            "fax_number": "843-718-1438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 GARNER ROAD",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "29303",
            "telephone_number": "864-541-0028",
            "fax_number": "864-541-0027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE MOBILITY UPSTATE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-25",
        "last_updated": "2017-06-26",
        "status": "A",
        "authorized_official_last_name": "HOOPER",
        "authorized_official_first_name": "CLARENCE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "843-577-9577",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "CPO"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "SC",
            "license": "042523929",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DE3088",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carolina Orthotics and Prosthetics LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Sydney Cathleen Achee, DO
• Lily Ackerman, RD
• Ashlon Brewington Adair
• Tracy Noel Adair, LISW-CP
• Adam R Blumer, DMD PC (Carolina Center for Oral and Maxillofacial Surgery)
• Frederick F Adams III, MD
• Joia Adams

• Prosthetic/Orthotic Supplier in Spartanburg, SC
• Providers in Spartanburg, 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 Jun 26, 2017; 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.