Provider Demographics
NPI:1285666917
Name:RUBEL, JAMES P (CPO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:RUBEL
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9526
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603-9526
Mailing Address - Country:US
Mailing Address - Phone:828-326-7161
Mailing Address - Fax:
Practice Address - Street 1:1636 TATE BLVD SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4244
Practice Address - Country:US
Practice Address - Phone:828-326-7161
Practice Address - Fax:828-326-9391
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X, 1744P3200X
NCCPO01474222Z00000X, 224P00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No174400000XOther Service ProvidersSpecialist
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7700567Medicaid
0551960003Medicare NSC
0551960002Medicare NSC
0551960001Medicare NSC