1225450380 NPI number — CENTER FOR ORTHOTIC AND PROSTHETIC CARE OF NORTH CAROLINA, INC

Table of content: (NPI 1225450380)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225450380 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:
Provider Other Organization Name Type Code:
6
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:
1225450380
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
790 PRE EMPTION RD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
GENEVA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14456-2018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-325-0024
Provider Business Mailing Address Fax Number:
315-325-0025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
790 PRE EMPTION RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
GENEVA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14456-2018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-325-0024
Provider Business Practice Location Address Fax Number:
315-325-0025
Provider Enumeration Date:
01/09/2014

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

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

  • Identifier: 04395777 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com