1700862224 NPI number — ASHEVILLE ORTHOTIC PROSTHETIC CENTER, LLC

Table of content: (NPI 1700862224)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700862224 NPI number — ASHEVILLE ORTHOTIC PROSTHETIC CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASHEVILLE ORTHOTIC PROSTHETIC CENTER, LLC
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:
ABILITY PROSTHETICS & ORTHOTICS
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:
1700862224
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
660 W LINCOLN HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EXTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19341-2514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-873-6733
Provider Business Mailing Address Fax Number:
610-873-6735

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 WALDEN RIDGE DR
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-252-0331
Provider Business Practice Location Address Fax Number:
828-252-9764
Provider Enumeration Date:
12/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BARROW
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
CLAYTON
Authorized Official Title or Position:
CIO
Authorized Official Telephone Number:
410-861-2446

Provider Taxonomy Codes

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

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

  • Identifier: 0486M . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 14317 . This is a "PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7701450 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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