Provider Demographics
NPI:1689804106
Name:NORTH CAROLINA ORTHOTICS & PROSTHETICS OF GOLDSBORO
Entity Type:Organization
Organization Name:NORTH CAROLINA ORTHOTICS & PROSTHETICS OF GOLDSBORO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:STAUFFER
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:919-736-1010
Mailing Address - Street 1:9650 STRICKLAND RD
Mailing Address - Street 2:SUITE 103-402
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-1902
Mailing Address - Country:US
Mailing Address - Phone:919-736-1010
Mailing Address - Fax:919-736-1011
Practice Address - Street 1:1306 WAYNE MEMORIAL DR
Practice Address - Street 2:SUITE C
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-2257
Practice Address - Country:US
Practice Address - Phone:919-736-1010
Practice Address - Fax:919-736-1011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-17
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC332BC3200X
DE2479335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7705090Medicaid
NC7795078Medicaid
NC7705090Medicaid