Provider Demographics
NPI:1659775948
Name:CAROLINAS PROSTHETICS AND ORTHOTHICS
Entity Type:Organization
Organization Name:CAROLINAS PROSTHETICS AND ORTHOTHICS
Other - Org Name:CPO
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MANSFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:CPED, CO, BOCPO
Authorized Official - Phone:910-556-4888
Mailing Address - Street 1:118 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-7016
Mailing Address - Country:US
Mailing Address - Phone:910-556-4888
Mailing Address - Fax:910-498-1002
Practice Address - Street 1:118 W 3RD ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-7016
Practice Address - Country:US
Practice Address - Phone:910-556-4888
Practice Address - Fax:910-498-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier