1790100881 NPI number — ATLANTIC PROSTHETICS & ORTHOTICS, LLC

Table of content: (NPI 1790100881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790100881 NPI number — ATLANTIC PROSTHETICS & ORTHOTICS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATLANTIC PROSTHETICS & ORTHOTICS, 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:
CRCR OFFICE
Provider Other Organization Name Type Code:
5
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:
1790100881
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 TIMBERHILL PL
Provider Second Line Business Mailing Address:
STE. 203
Provider Business Mailing Address City Name:
CHAPEL HILL
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27514-1596
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-945-0215
Provider Business Mailing Address Fax Number:
919-945-0220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2709 BLUE RIDGE RD
Provider Second Line Business Practice Location Address:
STE. 220
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27607-6462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-882-0020
Provider Business Practice Location Address Fax Number:
919-784-4613
Provider Enumeration Date:
02/26/2014

Additional Information

Authorized Official

Authorized Official Last Name:
BARHAM
Authorized Official First Name:
JILL
Authorized Official Middle Name:
Authorized Official Title or Position:
PARTNER/CO-OWNER
Authorized Official Telephone Number:
919-945-0215

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com