Provider Demographics
NPI:1598889016
Name:MITCHELL, RICHARD A (CO, BOCPO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:CO, BOCPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-3706
Mailing Address - Country:US
Mailing Address - Phone:910-641-9179
Mailing Address - Fax:
Practice Address - Street 1:702 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-3706
Practice Address - Country:US
Practice Address - Phone:910-641-9179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795371Medicaid