1821451980 NPI number — SKYLAND PROSTHETICS & ORTHOTICS, INC

Table of content: (NPI 1821451980)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821451980 NPI number — SKYLAND PROSTHETICS & ORTHOTICS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SKYLAND PROSTHETICS & ORTHOTICS, 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:
1821451980
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3845 HENDERSONVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLETCHER
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28732-8241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-631-1379
Provider Business Mailing Address Fax Number:
828-631-3622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
583 ASHEVILLE HWY
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
SYLVA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28779-5101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-631-1379
Provider Business Practice Location Address Fax Number:
828-631-3622
Provider Enumeration Date:
04/05/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CRONK
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
BILLING ADMINISTRATOR
Authorized Official Telephone Number:
828-684-1644

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7700057 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".