Provider Demographics
NPI:1043526700
Name:HARRIS, RALPH SCOTT (CPO)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:SCOTT
Last Name:HARRIS
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 ATLANTIC DR
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-2681
Mailing Address - Country:US
Mailing Address - Phone:252-622-4572
Mailing Address - Fax:
Practice Address - Street 1:12 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-7325
Practice Address - Country:US
Practice Address - Phone:910-353-9002
Practice Address - Fax:910-353-9003
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2022-04-05
Deactivation Date:2018-05-21
Deactivation Code:
Reactivation Date:2019-05-14
Provider Licenses
StateLicense IDTaxonomies
222Z00000X, 224P00000X
CPO02491224P00000X, 222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795480Medicaid