Provider Demographics
NPI:1790747244
Name:ORTHO PROS EXPRESS INC
Entity Type:Organization
Organization Name:ORTHO PROS EXPRESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MULLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-749-6291
Mailing Address - Street 1:9307 MONROE RD STE M
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-1485
Mailing Address - Country:US
Mailing Address - Phone:704-921-2286
Mailing Address - Fax:704-831-8300
Practice Address - Street 1:9307 MONROE RD STE M
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-1485
Practice Address - Country:US
Practice Address - Phone:704-921-2286
Practice Address - Fax:704-831-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7701803Medicaid
SCDME958Medicaid
VA9113738Medicaid
SCDME958Medicaid