Healthcare Provider Details

I. General information

NPI: 1588730386
Provider Name (Legal Business Name): BECKLEY ORTHOTICS AND PROSTHETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 NORTH VANCE DRIVE
BECKLEY WV
25801-0471
US

IV. Provider business mailing address

471 NORTH VANCE DRIVE
BECKLEY WV
25801-0471
US

V. Phone/Fax

Practice location:
  • Phone: 304-254-8285
  • Fax: 304-254-8286
Mailing address:
  • Phone: 304-254-8285
  • Fax: 304-254-8286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID EDWARD PAYNE
Title or Position: PRESIDENT
Credential: CPO BOCP
Phone: 304-254-8285