Provider Demographics
NPI:1659472926
Name:ALBEMARLE ORTHOTICS & PROSTHETICS, INC
Entity Type:Organization
Organization Name:ALBEMARLE ORTHOTICS & PROSTHETICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-338-3002
Mailing Address - Street 1:405 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-3524
Mailing Address - Country:US
Mailing Address - Phone:252-940-1203
Mailing Address - Fax:252-940-1206
Practice Address - Street 1:405 W 15TH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3524
Practice Address - Country:US
Practice Address - Phone:252-940-1203
Practice Address - Fax:252-940-1206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 335E00000X
NC332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7705351Medicaid
NC0482POtherBCBS
NC0482POtherBCBS
NC0782190004Medicare NSC
VA384410OtherBCBS
VA9190511Medicaid