Healthcare Provider Details

I. General information

NPI: 1902801244
Provider Name (Legal Business Name): LEVEL FOUR ORTHOTICS & PROSTHETICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 05/15/2020
Certification Date: 05/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1673 WESTBROOK PLAZA DR STE 230
WINSTON SALEM NC
27103-3068
US

IV. Provider business mailing address

2534 EMPIRE DR
WINSTON SALEM NC
27103-6710
US

V. Phone/Fax

Practice location:
  • Phone: 336-765-2425
  • Fax: 336-765-8370
Mailing address:
  • Phone: 336-397-2165
  • Fax: 336-397-2167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberNA
License Number StateNC

VIII. Authorized Official

Name: JANET WOODALL
Title or Position: DIRECTOR, CONTRACTING
Credential:
Phone: 336-397-0993