Provider Demographics
NPI:1497752026
Name:ECONOMED OF ABERDEEN INC
Entity Type:Organization
Organization Name:ECONOMED OF ABERDEEN INC
Other - Org Name:ORTHOTICS & PROSTHETICS OF PINEHURST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELEASE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-295-4489
Mailing Address - Street 1:95 AVIEMORE DR
Mailing Address - Street 2:STE A
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9797
Mailing Address - Country:US
Mailing Address - Phone:910-295-4489
Mailing Address - Fax:910-215-8035
Practice Address - Street 1:95 AVIEMORE DR
Practice Address - Street 2:STE A
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9797
Practice Address - Country:US
Practice Address - Phone:910-295-4489
Practice Address - Fax:910-215-8035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC04977OtherBC/BS
NC7700636Medicaid
NC7700636Medicaid