Healthcare Provider Details

I. General information

NPI: 1760900146
Provider Name (Legal Business Name): CENTER FOR ORTHOTIC AND PROSTHETIC CARE OF NORTH CAROLINA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 02/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 N ROXBORO ST STE 112
DURHAM NC
27704-2181
US

IV. Provider business mailing address

32 E VARGO RD
HORSEHEADS NY
14845-9319
US

V. Phone/Fax

Practice location:
  • Phone: 984-219-2595
  • Fax: 984-219-7542
Mailing address:
  • Phone: 607-442-1740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: GRACE ANGELINE
Title or Position: REG COMPLIANCE SPECIALIST III
Credential:
Phone: 714-961-2102