Provider Demographics
NPI:1437110905
Name:CAPE FEAR ORTHOTICS & PROSTHETICS, INC.
Entity Type:Organization
Organization Name:CAPE FEAR ORTHOTICS & PROSTHETICS, INC.
Other - Org Name:CAPE FEAR O&P
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DIMITRI
Authorized Official - Middle Name:K
Authorized Official - Last Name:SLEEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-483-0933
Mailing Address - Street 1:PO BOX 58611
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-8611
Mailing Address - Country:US
Mailing Address - Phone:910-483-0933
Mailing Address - Fax:910-483-9622
Practice Address - Street 1:435 W RUSSELL ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5576
Practice Address - Country:US
Practice Address - Phone:910-483-0933
Practice Address - Fax:910-483-9622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01063332B00000X, 332BC3200X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7703059Medicaid
NC1280490001Medicare ID - Type UnspecifiedFAYETTEVILLE, NC