=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922048313
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEVEL FOUR ORTHOTICS & PROSTHETICS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2006
-----------------------------------------------------
Last Update Date | 07/23/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1901 BRUNSWICK AVE SUITE 240
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28207-2809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-348-4488
-----------------------------------------------------
Fax | 704-348-4496
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2534 EMPIRE DR
-----------------------------------------------------
City | WINSTON SALEM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27103-6710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-397-2165
-----------------------------------------------------
Fax | 336-397-2167
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR, CONTRACTING
-----------------------------------------------------
Name | JANET WOODALL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 336-397-0993
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------