1821569294 NPI number — ATLANTIC COAST ORTHOPEDIC MEDICAL SUPPLIES

Table of content: (NPI 1821569294)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821569294 NPI number — ATLANTIC COAST ORTHOPEDIC MEDICAL SUPPLIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATLANTIC COAST ORTHOPEDIC MEDICAL SUPPLIES
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:
1821569294
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 744966
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-4966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-921-0116
Provider Business Mailing Address Fax Number:
704-921-0117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9006 PERIMETER WOODS DR STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28216-2466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-921-0116
Provider Business Practice Location Address Fax Number:
704-921-0117
Provider Enumeration Date:
12/11/2018

Additional Information

Authorized Official

Authorized Official Last Name:
REBAGLIA
Authorized Official First Name:
LISA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
704-749-6284

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 © 2007-2025 www.npivalidator.com