Provider Demographics
NPI:1689992851
Name:ADVANCED BRACE & LIMB
Entity Type:Organization
Organization Name:ADVANCED BRACE & LIMB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:P
Authorized Official - Last Name:ENEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-818-0359
Mailing Address - Street 1:3617 NIGHTFALL CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6370
Mailing Address - Country:US
Mailing Address - Phone:919-818-0359
Mailing Address - Fax:800-967-4245
Practice Address - Street 1:4140 FERNCREEK DR
Practice Address - Street 2:SUITE 803
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-2572
Practice Address - Country:US
Practice Address - Phone:919-818-0359
Practice Address - Fax:800-967-4245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6439500001Medicare NSC