Healthcare Provider Details

I. General information

NPI: 1124025978
Provider Name (Legal Business Name): FAITH PROSTHETIC-ORTHOTIC SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 09/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 COX RD
GASTONIA NC
28054-0628
US

IV. Provider business mailing address

561 COX RD
GASTONIA NC
28054-0628
US

V. Phone/Fax

Practice location:
  • Phone: 704-866-7772
  • Fax: 704-866-4292
Mailing address:
  • Phone: 704-866-7772
  • Fax: 704-866-4292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateNC

VIII. Authorized Official

Name: SHERYL S PRICE
Title or Position: DIRECTOR OF REIMBURSEMENT
Credential:
Phone: 503-493-8288