Provider Demographics
NPI:1801066170
Name:ASHEVILLE ORTHOTIC PROSTHETIC CENTER LLC
Entity type:Organization
Organization Name:ASHEVILLE ORTHOTIC PROSTHETIC CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CIO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:CLAYTON
Authorized Official - Last Name:BARROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-861-2446
Mailing Address - Street 1:660 W LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2514
Mailing Address - Country:US
Mailing Address - Phone:610-873-6733
Mailing Address - Fax:610-873-6735
Practice Address - Street 1:309 S SHARON AMITY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211
Practice Address - Country:US
Practice Address - Phone:704-372-7660
Practice Address - Fax:704-372-7659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7704970Medicaid
NC0938760002Medicare NSC