=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003104076
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OWENS CAROLINA ORTHOTIC & PROSTHETIC NETWORK,INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2011
-----------------------------------------------------
Last Update Date | 02/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10550 SOUTHERN LOOP BLVD
-----------------------------------------------------
City | PINEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28134-7383
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-332-5143
-----------------------------------------------------
Fax | 866-670-5370
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 7263
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28241-7263
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-332-5143
-----------------------------------------------------
Fax | 704-332-6128
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | WILLIAM T OWENS
-----------------------------------------------------
Credential | CO
-----------------------------------------------------
Telephone | 704-332-5143
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------