1770589368 NPI number — CENTER FOR ORTHOTIC AND PROSTHETIC CARE OF NORTH CAROLINA INC

Table of content: (NPI 1770589368)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770589368 NPI number — CENTER FOR ORTHOTIC AND PROSTHETIC CARE OF NORTH CAROLINA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR ORTHOTIC AND PROSTHETIC CARE OF NORTH CAROLINA INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HANGER CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770589368
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4155 E LA PALMA AVE STE B400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANAHEIM
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92807-1857
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-961-2102
Provider Business Mailing Address Fax Number:
737-209-6653

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MO4 DAVISON BLDG
Provider Second Line Business Practice Location Address:
DUMC
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27710-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-684-2474
Provider Business Practice Location Address Fax Number:
919-613-6511
Provider Enumeration Date:
06/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ANGELINE
Authorized Official First Name:
GRACE
Authorized Official Middle Name:
Authorized Official Title or Position:
REG COMPLIANCE SPECIALIST III
Authorized Official Telephone Number:
714-961-2102

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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