Healthcare Provider Details

I. General information

NPI: 1871776039
Provider Name (Legal Business Name): JAMES P RUBEL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1636 TATE BLVD SE
HICKORY NC
28602-4244
US

IV. Provider business mailing address

PO BOX 9526
HICKORY NC
28603-9526
US

V. Phone/Fax

Practice location:
  • Phone: 828-326-7161
  • Fax: 828-326-9391
Mailing address:
  • Phone: 828-326-7161
  • Fax: 828-326-9391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier7700567
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: MR. JAMES P RUBEL
Title or Position: OWNER
Credential: C.P.O.
Phone: 828-326-7161