Provider Demographics
NPI:1508820887
Name:ORTHOPEDIC SERVICE CO OF RALEIGH,INC
Entity Type:Organization
Organization Name:ORTHOPEDIC SERVICE CO OF RALEIGH,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:WENDT
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:919-878-7183
Mailing Address - Street 1:2521 NOBLIN RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-2415
Mailing Address - Country:US
Mailing Address - Phone:919-878-7183
Mailing Address - Fax:919-878-7151
Practice Address - Street 1:2521 NOBLIN RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-2415
Practice Address - Country:US
Practice Address - Phone:919-878-7183
Practice Address - Fax:919-878-7151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00176332B00000X
332BC3200X
NCCP003475335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7700326Medicaid
NC0444230001Medicare ID - Type Unspecified