Provider Demographics
NPI:1639286453
Name:W JASON METZGER
Entity Type:Organization
Organization Name:W JASON METZGER
Other - Org Name:METZGER'S FOOTCARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:METZGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-799-0200
Mailing Address - Street 1:248 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-2528
Mailing Address - Country:US
Mailing Address - Phone:704-799-0200
Mailing Address - Fax:704-799-0240
Practice Address - Street 1:248 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2528
Practice Address - Country:US
Practice Address - Phone:704-799-0200
Practice Address - Fax:704-799-0240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========OtherTAX ID NUMBER
NC=========OtherTAX ID NUMBER