1447420385 NPI number — MR. RICKEY DALE CARROW ORTHOTIST

Table of content: MR. RICKEY DALE CARROW ORTHOTIST (NPI 1447420385)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447420385 NPI number — MR. RICKEY DALE CARROW ORTHOTIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARROW
Provider First Name:
RICKEY
Provider Middle Name:
DALE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
ORTHOTIST
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARROW
Provider Other First Name:
RICKEY
Provider Other Middle Name:
DALE
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ORTHOTIST
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1447420385
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
168 JEFFERSON RD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PINETOWN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27865-9463
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-927-2088
Provider Business Mailing Address Fax Number:
252-927-2088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
168 JEFFERSON RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINETOWN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27865-9463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-927-2088
Provider Business Practice Location Address Fax Number:
252-927-2088
Provider Enumeration Date:
03/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 222Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1744P3200X , with the licence number: CO003664 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com