1598075392 NPI number — CENTER FOR ORTHOTIC AND PROSTHETIC CARE OF NORTH CAROLINA INC

Table of content: (NPI 1598075392)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598075392 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:
1598075392
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P O 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's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 RAILROAD AVENUE
Provider Second Line Business Practice Location Address:
SUITE 2-5
Provider Business Practice Location Address City Name:
COOPERSTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13326-1169
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-547-4066
Provider Business Practice Location Address Fax Number:
607-547-5011
Provider Enumeration Date:
10/14/2010

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: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X , with the licence number: NOT APPLICABLE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 003355424 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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