Healthcare Provider Details

I. General information

NPI: 1760583033
Provider Name (Legal Business Name): ALBEMARLE ORTHOTICS & PROSTHETICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 BURNETTS WAY STE 104
SUFFOLK VA
23434-6149
US

IV. Provider business mailing address

106 MEDICAL DR.
ELIZABETH CITY NC
27909
US

V. Phone/Fax

Practice location:
  • Phone: 757-934-2676
  • Fax: 757-934-2751
Mailing address:
  • Phone: 252-338-3002
  • Fax: 252-338-2902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KIMBERLY S WILLIAMSON
Title or Position: OWNER
Credential:
Phone: 252-338-3002