Healthcare Provider Details

I. General information

NPI: 1144534462
Provider Name (Legal Business Name): H STADIEM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2010
Last Update Date: 07/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 NORTH QUEEN STREET
KINSTON NC
28501-4928
US

IV. Provider business mailing address

124 NORTH QUEEN STREET
KINSTON NC
28501-4928
US

V. Phone/Fax

Practice location:
  • Phone: 252-527-1166
  • Fax: 252-527-3240
Mailing address:
  • Phone: 252-527-1166
  • Fax: 252-527-3240

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: MR. HYMAN STADIEM
Title or Position: OWNER/MANAGER
Credential:
Phone: 252-527-1166