Provider Demographics
NPI:1124404637
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/SECRETARY/TREASURE
Authorized Official - Prefix:
Authorized Official - First Name:OWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:AYCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:COP
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 1:910 TATE BLVD SE STE 103
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4030
Practice Address - Country:US
Practice Address - Phone:828-254-6305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOPEDIC APPLIANCE COMPANY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-06
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCPO00805332BC3200X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment