Provider Demographics
NPI:1225450380
Name:CENTER FOR ORTHOTIC AND PROSTHETIC CARE OF NORTH CAROLINA, INC
Entity Type:Organization
Organization Name:CENTER FOR ORTHOTIC AND PROSTHETIC CARE OF NORTH CAROLINA, INC
Other - Org Name:CENTER FOR ORTHOTIC AND PROSTHETIC CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:REG COMPLIANCE SPECIALIST III
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGELINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-961-2102
Mailing Address - Street 1:790 PRE EMPTION RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-2018
Mailing Address - Country:US
Mailing Address - Phone:315-325-0024
Mailing Address - Fax:315-325-0025
Practice Address - Street 1:790 PRE EMPTION RD
Practice Address - Street 2:SUITE B
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-2018
Practice Address - Country:US
Practice Address - Phone:315-325-0024
Practice Address - Fax:315-325-0025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-09
Last Update Date:2019-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04395777Medicaid
NY4120510010Medicare NSC