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General NPI Number Information
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NPI Number | 1689804106
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Entity Type | Organization
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Legal Business Name | NORTH CAROLINA ORTHOTICS & PROSTHETICS OF GOLDSBORO
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Dates
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Enumeration Date | 07/17/2009
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Last Update Date | 09/18/2013
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Provider Practice Location Address
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Address Line | 1306 WAYNE MEMORIAL DR SUITE C
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City | GOLDSBORO
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State | NC
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Zip | 27534-2257
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Country | US
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Telephone | 919-736-1010
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Fax | 919-736-1011
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Provider Business Mailing Address
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Address Line | 9650 STRICKLAND RD SUITE 103-402
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City | RALEIGH
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State | NC
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Zip | 27615-1902
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Country | US
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Telephone | 919-736-1010
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Fax | 919-736-1011
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WILLIAM STANLEY STAUFFER
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Credential | CPO
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Telephone | 919-736-1010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 2479
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License Number State | DE
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