1265420335 NPI number — HANGER PROSTHETICS & ORTHOTICS EAST INC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265420335 NPI number — HANGER PROSTHETICS & ORTHOTICS EAST INC

Employer Identification Number (EIN):

Provider Organization Name:

HANGER PROSTHETICS & ORTHOTICS EAST 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 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:

1265420335

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

03/09/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 650846

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

DALLAS

Provider Business Mailing Address State Name:

TX

Provider Business Mailing Address Postal Code:

75265-0846

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

1399 WESTGATE CENTER DR

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

WINSTON SALEM

Provider Business Practice Location Address State Name:

NC

Provider Business Practice Location Address Postal Code:

27103-2933

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

336-768-1933

Provider Business Practice Location Address Fax Number:

336-768-4869

Provider Enumeration Date:

10/12/2005

Authorized Official Last Name:

ANGELINE

Authorized Official First Name:

GRACE

Authorized Official Middle Name:

Authorized Official Title or Position:

REG COMPLIANCE SPECIALIST IV

Authorized Official Telephone Number:

714-961-2102

• Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 332BC3200X , with the licence number: 562182959 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0487N . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 32953 . This is a "PARTNERS MEDICARE CHOICE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 7795063 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
• Identifier: 4496224 . This is a "NON HMO AETNA NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 9110925 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
• Identifier: 2021053 . This is a "HMO AETNA NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: A9348 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 7703164 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".