Provider Demographics
NPI:1104828342
Name:ORTHOPEDIC APPLIANCE CO INC
Entity Type:Organization
Organization Name:ORTHOPEDIC APPLIANCE CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OWEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:AYCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:828-254-6305
Mailing Address - Street 1:75 VICTORIA RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4419
Mailing Address - Country:US
Mailing Address - Phone:828-254-6305
Mailing Address - Fax:828-254-6110
Practice Address - Street 1:75 VICTORIA RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4419
Practice Address - Country:US
Practice Address - Phone:828-254-6305
Practice Address - Fax:828-254-6110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BC3200X
NC00148335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC04916OtherBCBS OF NC
NC7700122Medicaid
NC7700122Medicaid