Provider Demographics
NPI:1780135269
Name:WESTERN CAROLINA O & P
Entity type:Organization
Organization Name:WESTERN CAROLINA O & P
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ROBERTS
Authorized Official - Last Name:WIGGEN
Authorized Official - Suffix:
Authorized Official - Credentials:COF
Authorized Official - Phone:828-595-9371
Mailing Address - Street 1:107 E WALKER ST
Mailing Address - Street 2:
Mailing Address - City:EAST FLAT ROCK
Mailing Address - State:NC
Mailing Address - Zip Code:28726-2235
Mailing Address - Country:US
Mailing Address - Phone:828-595-9371
Mailing Address - Fax:828-595-9373
Practice Address - Street 1:366 S PINE ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-2624
Practice Address - Country:US
Practice Address - Phone:864-208-1745
Practice Address - Fax:864-208-1778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment