MEDICARE: ALBEMARLE ORTHOTICS & PROSTHETICS, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	335E00000X	Prosthetic/Orthotic Supplier
3	332BC3200X	Customized Equipment (DME)	NC

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	:	1659472926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALBEMARLE ORTHOTICS & PROSTHETICS, INC

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

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

Authorized Official
Title or Position	:	OWNER
Name	:	KIMBERLY S WILLIAMSON
Credential	:
Telephone Number	:	252-338-3002

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	12/09/2020

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