Provider Demographics
NPI:1881643807
Name:OWENS CAROLINA ORTHOTIC & PROSTHETIC NETWORK, INC.
Entity Type:Organization
Organization Name:OWENS CAROLINA ORTHOTIC & PROSTHETIC NETWORK, INC.
Other - Org Name:OWENS CAROLINA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:704-332-5143
Mailing Address - Street 1:PO BOX 7263
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28241-7263
Mailing Address - Country:US
Mailing Address - Phone:704-332-5143
Mailing Address - Fax:866-670-5370
Practice Address - Street 1:3535 RANDOLPH RD STE 210
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-5027
Practice Address - Country:US
Practice Address - Phone:704-332-5143
Practice Address - Fax:866-670-5370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7705024Medicaid
NC0261530002Medicare NSC