Provider Demographics
NPI:1164890745
Name:CREATIVE PROSTHETICS AND ORTHOTICS LLC
Entity Type:Organization
Organization Name:CREATIVE PROSTHETICS AND ORTHOTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MRS
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:RIFFLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-787-3707
Mailing Address - Street 1:3305 16TH AVE SE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-9213
Mailing Address - Country:US
Mailing Address - Phone:704-787-3707
Mailing Address - Fax:
Practice Address - Street 1:3305 16TH AVE SE
Practice Address - Street 2:SUITE 101
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-9213
Practice Address - Country:US
Practice Address - Phone:704-787-3707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-13
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7506030001Medicare NSC