MEDICARE: CENTER FOR ORTHOTIC AND PROSTHETIC CARE OF NORTH CAROLINA INC

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	335E00000X	Prosthetic/Orthotic Supplier		NC

General Provider Information

NPI Number	:	1770589368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR ORTHOTIC AND PROSTHETIC CARE OF NORTH CAROLINA INC

Provider Business Mailing Address
First Line	:	4155 E LA PALMA AVE STE B400
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92807-1857
Country	:	US
Telephone Number	:	714-961-2102
Fax Number	:	737-209-6653

Provider Business Practice Location Address
First Line	:	MO4 DAVISON BLDG
Second Line	:	DUMC
City	:	DURHAM
State	:	NC
Zip	:	27710-0001
Country	:	US
Telephone Number	:	919-684-2474
Fax Number	:	919-613-6511

Authorized Official
Title or Position	:	REG COMPLIANCE SPECIALIST III
Name	:	GRACE ANGELINE
Credential	:
Telephone Number	:	714-961-2102

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	04/16/2020

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