Provider Demographics
NPI:1891738381
Name:BEYER, KURT F (CPO)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:F
Last Name:BEYER
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 S HIGHWAY 16
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:NC
Mailing Address - Zip Code:28164-8709
Mailing Address - Country:US
Mailing Address - Phone:704-822-8005
Mailing Address - Fax:704-822-8828
Practice Address - Street 1:1095 S HIGHWAY 16
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:NC
Practice Address - Zip Code:28164-8709
Practice Address - Country:US
Practice Address - Phone:704-822-8005
Practice Address - Fax:704-822-8828
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2673224P00000X
NCC26289222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795308Medicaid
NC6487083OtherCIGNA
NC046AJOtherBCBS
NC7795308Medicaid