Provider Demographics
NPI:1942488762
Name:JOHN J. O'CONNOR CPO INC
Entity Type:Organization
Organization Name:JOHN J. O'CONNOR CPO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V-PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-724-6871
Mailing Address - Street 1:900 S HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4417
Mailing Address - Country:US
Mailing Address - Phone:336-724-6871
Mailing Address - Fax:336-724-6871
Practice Address - Street 1:900 S HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4417
Practice Address - Country:US
Practice Address - Phone:336-724-6871
Practice Address - Fax:336-724-6871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7700250Medicaid
NC0495BOtherBLUE CROSS BLUE SHIELD
NC7700250Medicaid