Provider Demographics
NPI:1790736379
Name:ORTHOTICS & PROSTHETICS EAST INC
Entity Type:Organization
Organization Name:ORTHOTICS & PROSTHETICS EAST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:COLTRAIN
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:252-215-2215
Mailing Address - Street 1:1025 WH SMITH BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5052
Mailing Address - Country:US
Mailing Address - Phone:252-215-2215
Mailing Address - Fax:252-215-2216
Practice Address - Street 1:1025 WH SMITH BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5052
Practice Address - Country:US
Practice Address - Phone:252-215-2215
Practice Address - Fax:252-215-2216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7704508Medicaid
NC0464JOtherBCBS NC #
NC7704508Medicaid
NC0464JOtherBCBS NC #