Healthcare Provider Details

I. General information

NPI: 1699910349
Provider Name (Legal Business Name): SUMMIT PROSTHETICS & ORTHOTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2008
Last Update Date: 12/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 PROCURE DR SUITE 300
FUQUAY VARINA NC
27526-2627
US

IV. Provider business mailing address

1006 PROCURE DR SUITE 300
FUQUAY VARINA NC
27526-2627
US

V. Phone/Fax

Practice location:
  • Phone: 919-552-1464
  • Fax: 919-552-1465
Mailing address:
  • Phone: 919-552-1464
  • Fax: 919-552-1465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberCPO02014
License Number StateDE

VIII. Authorized Official

Name: MR. MIKE DRISCOLL
Title or Position: PRESIDENT
Credential:
Phone: 919-812-0153