Provider Demographics
NPI:1538489885
Name:A PLUS DIABETIC FOOTWEAR AND SUPPLIES
Entity Type:Organization
Organization Name:A PLUS DIABETIC FOOTWEAR AND SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:I
Authorized Official - Last Name:JARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT, CFTS
Authorized Official - Phone:704-322-9618
Mailing Address - Street 1:1205 ASH ST
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-2704
Mailing Address - Country:US
Mailing Address - Phone:704-322-9618
Mailing Address - Fax:866-756-6225
Practice Address - Street 1:951 N 1ST ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3353
Practice Address - Country:US
Practice Address - Phone:704-322-9618
Practice Address - Fax:866-756-6225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-09
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC002026879335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6598570001Medicare NSC