Provider Demographics
NPI: | 1790101442 |
---|---|
Name: | ATLANTIC PROSTHETICS & ORTHOTICS, LLC |
Entity Type: | Organization |
Organization Name: | ATLANTIC PROSTHETICS & ORTHOTICS, LLC |
Other - Org Name: | CRC OFFICE |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | PARTNER/CO-OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JILL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BARHAM |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | CPO |
Authorized Official - Phone: | 919-945-0215 |
Mailing Address - Street 1: | 200 TIMBERHILL PL |
Mailing Address - Street 2: | STE. 203 |
Mailing Address - City: | CHAPEL HILL |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 27514-1596 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 919-945-0215 |
Mailing Address - Fax: | 919-945-0220 |
Practice Address - Street 1: | 1807 FORDHAM BLVD |
Practice Address - Street 2: | |
Practice Address - City: | CHAPEL HILL |
Practice Address - State: | NC |
Practice Address - Zip Code: | 27514-2200 |
Practice Address - Country: | US |
Practice Address - Phone: | 919-595-9649 |
Practice Address - Fax: | 919-595-9696 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-03-05 |
Last Update Date: | 2014-03-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332BC3200X | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment |