Provider Demographics
NPI:1972566016
Name:SANDHILLS ORTHOTICS, LLC
Entity Type:Organization
Organization Name:SANDHILLS ORTHOTICS, LLC
Other - Org Name:SANDHILLS ORTHOTICS & PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:V
Authorized Official - Last Name:O'REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-295-2828
Mailing Address - Street 1:PO BOX 4754
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-4754
Mailing Address - Country:US
Mailing Address - Phone:910-295-2828
Mailing Address - Fax:910-295-2996
Practice Address - Street 1:325 N PAGE RD
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374
Practice Address - Country:US
Practice Address - Phone:910-295-2828
Practice Address - Fax:910-295-2996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7703340Medicaid
NC7703340Medicaid
NC5376750001Medicare ID - Type Unspecified