Provider Demographics
NPI:1073663373
Name:TEST ME OUT INC
Entity Type:Organization
Organization Name:TEST ME OUT INC
Other - Org Name:SECOND NATURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANIS
Authorized Official - Middle Name:T
Authorized Official - Last Name:GASKILL
Authorized Official - Suffix:
Authorized Official - Credentials:CMF
Authorized Official - Phone:252-635-6770
Mailing Address - Street 1:3262 WELLONS BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5234
Mailing Address - Country:US
Mailing Address - Phone:252-635-6770
Mailing Address - Fax:252-635-9577
Practice Address - Street 1:3262 WELLONS BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5234
Practice Address - Country:US
Practice Address - Phone:252-635-6770
Practice Address - Fax:252-635-9577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC018518335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0423VOtherBCBS PROVIDER NUMBER
NC7701949Medicaid
NC0423VOtherBCBS PROVIDER NUMBER