Provider Demographics
NPI:1760583033
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 1:106 MEDICAL DR.
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909
Mailing Address - Country:US
Mailing Address - Phone:252-338-3002
Mailing Address - Fax:252-338-2902
Practice Address - Street 1:148 BURNETTS WAY STE 104
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-6149
Practice Address - Country:US
Practice Address - Phone:757-934-2676
Practice Address - Fax:757-934-2751
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 Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA384410OtherBCBS
NC0482POtherBCBS
NC7701327Medicaid
VA9190511Medicaid
0782190001Medicare ID - Type Unspecified
VA0782190002Medicare NSC