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General NPI Number Information
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NPI Number | 1891050357
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Entity Type | Organization
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Legal Business Name | OUTER BANKS PROFESSIONAL SERVICES, LLC
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Dates
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Enumeration Date | 07/11/2012
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Last Update Date | 07/14/2021
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Provider Practice Location Address
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Address Line | 4800 S CROATAN HWY
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City | NAGS HEAD
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State | NC
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Zip | 27959-9704
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Country | US
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Telephone | 252-449-4500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8427
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City | GREENVILLE
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State | NC
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Zip | 27835-8427
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MR. TODD WARTLITNER
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Credential |
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Telephone | 252-449-4518
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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