MEDICARE: STEPHEN GREGORY TRUESDALE CPO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Z00000X	Orthotist
2	224P00000X	Prosthetist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0482P	OTHER	NC	BCBS

General Provider Information

NPI Number	:	1316098023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN GREGORY TRUESDALE CPO

Provider Business Mailing Address
First Line	:	4153 HEARTHSIDE DR
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28412
Country	:	US
Telephone Number	:	919-995-9491
Fax Number	:	919-995-9491

Provider Business Practice Location Address
First Line	:	405 W 15TH ST
Second Line	:	201
City	:	WASHINGTON
State	:	NC
Zip	:	27889-3524
Country	:	US
Telephone Number	:	252-940-1203
Fax Number	:	252-940-1206

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	10/28/2014

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