Provider Demographics
NPI:1841212040
Name:ORTHO PROS EXPRESS
Entity Type:Organization
Organization Name:ORTHO PROS EXPRESS
Other - Org Name:SELECT REHAB MED DIRECT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:F
Authorized Official - Last Name:TRIMNAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-921-2286
Mailing Address - Street 1:2205 DISTRIBUTION CENTER DR STE A
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-4283
Mailing Address - Country:US
Mailing Address - Phone:704-921-2286
Mailing Address - Fax:704-921-2287
Practice Address - Street 1:2205 DISTRIBUTION CENTER DR STE A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-4283
Practice Address - Country:US
Practice Address - Phone:704-921-2286
Practice Address - Fax:704-921-2278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7701803Medicaid
VA9113738Medicaid
GA00945216BMedicaid
NC0395AOtherBLUE CROSS
VA282056OtherANTHEM
SCDME958Medicaid
WV0227447000Medicaid
NC7701803Medicaid