Healthcare Provider Details

I. General information

NPI: 1457889834
Provider Name (Legal Business Name): CHRISTIAN ROBERTS BEEN CP, BOCO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 N ELM ST STE 201
GREENSBORO NC
27401
US

IV. Provider business mailing address

2534 EMPIRE DR
WINSTON SALEM NC
27103-6710
US

V. Phone/Fax

Practice location:
  • Phone: 336-478-9400
  • Fax: 336-478-9404
Mailing address:
  • Phone: 336-397-2165
  • Fax: 336-397-2167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberC51530
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCP03333
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: