Healthcare Provider Details

I. General information

NPI: 1376830273
Provider Name (Legal Business Name): NORTH CAROLINA ORTHOTICS & PROSTHETICS OF ROCKY MOUNT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3721 SUNSET AVE
ROCKY MOUNT NC
27804-3327
US

IV. Provider business mailing address

2717 LEIGHTON RIDGE DR STE100
WAKE FOREST NC
27587-5987
US

V. Phone/Fax

Practice location:
  • Phone: 252-210-3472
  • Fax: 252-210-3473
Mailing address:
  • Phone: 252-535-0077
  • Fax: 252-535-0078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CINDY JOHNCOUR
Title or Position: OWNER
Credential:
Phone: 919-556-3402