Provider Demographics
NPI:1013235670
Name:CAROLINA PEDORTHICS INC
Entity type:Organization
Organization Name:CAROLINA PEDORTHICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:COLONEL
Authorized Official - Last Name:HUFFSTETLER
Authorized Official - Suffix:
Authorized Official - Credentials:CO,CPED
Authorized Official - Phone:828-859-3089
Mailing Address - Street 1:38A N.TRADE ST.
Mailing Address - Street 2:
Mailing Address - City:TRYON
Mailing Address - State:NC
Mailing Address - Zip Code:28782-6656
Mailing Address - Country:US
Mailing Address - Phone:828-859-3089
Mailing Address - Fax:828-859-9271
Practice Address - Street 1:38 N.TRADE ST.
Practice Address - Street 2:A
Practice Address - City:TRYON
Practice Address - State:NC
Practice Address - Zip Code:28782-6656
Practice Address - Country:US
Practice Address - Phone:828-859-3089
Practice Address - Fax:828-859-9271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795449Medicaid
NC7795449Medicaid