Provider Demographics
NPI:1235978677
Name:TIERNEY ORTHOTICS AND PROSTHETICS INC.
Entity type:Organization
Organization Name:TIERNEY ORTHOTICS AND PROSTHETICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CRANIAL
Authorized Official - Prefix:
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:TIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:336-830-4762
Mailing Address - Street 1:1345 WESTGATE CENTER DR STE B
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3041
Mailing Address - Country:US
Mailing Address - Phone:336-546-7165
Mailing Address - Fax:
Practice Address - Street 1:1409 YANCEYVILLE ST STE B
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6961
Practice Address - Country:US
Practice Address - Phone:336-537-3901
Practice Address - Fax:336-893-9537
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TIERNEY ORTHOTICS AND PROSTHETICS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment