Provider Demographics
NPI:1770130551
Name:LEVEL FOUR ORTHOTICS AND PROSTHETICS
Entity type:Organization
Organization Name:LEVEL FOUR ORTHOTICS AND PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-397-0993
Mailing Address - Street 1:2534 EMPIRE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6710
Mailing Address - Country:US
Mailing Address - Phone:336-397-0993
Mailing Address - Fax:
Practice Address - Street 1:107 E WALKER ST
Practice Address - Street 2:
Practice Address - City:EAST FLAT ROCK
Practice Address - State:NC
Practice Address - Zip Code:28726-2235
Practice Address - Country:US
Practice Address - Phone:828-595-9371
Practice Address - Fax:828-595-9373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier