Healthcare Provider Details

I. General information

NPI: 1043328214
Provider Name (Legal Business Name): TRIAD ORTHOTICS AND PEDORTHICS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 08/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2419 LEWISVILLE CLEMMONS RD SUITE 1
CLEMMONS NC
27012-8976
US

IV. Provider business mailing address

2419 LEWISVILLE CLEMMONS RD SUITE 1
CLEMMONS NC
27012-8977
US

V. Phone/Fax

Practice location:
  • Phone: 336-712-4750
  • Fax: 336-712-1056
Mailing address:
  • Phone: 336-712-4750
  • Fax: 336-712-1056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. PAUL ANDREW MANSFIELD
Title or Position: OWNER
Credential: C.O. C. PED.
Phone: 336-712-4750