Provider Demographics
NPI:1275616211
Name:PROSTHETIC ORTHOTIC CARE CENTER,INC
Entity Type:Organization
Organization Name:PROSTHETIC ORTHOTIC CARE CENTER,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:704-841-4388
Mailing Address - Street 1:1352 MATTHEWS TOWNSHIP PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-4985
Mailing Address - Country:US
Mailing Address - Phone:704-841-4388
Mailing Address - Fax:704-849-7727
Practice Address - Street 1:1352 MATTHEWS TOWNSHIP PKWY STE 101
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-4985
Practice Address - Country:US
Practice Address - Phone:704-841-4388
Practice Address - Fax:704-849-7727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7701190Medicaid
NC0521240001Medicare NSC