MEDICARE: CARDINAL PROSTHETICS & ORTHOTICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467479352
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDINAL PROSTHETICS & ORTHOTICS LLC

Provider Business Mailing Address
First Line	:	2654 VALLEY AVE
Second Line	:	SUITE D
City	:	WINCHESTER
State	:	VA
Zip	:	22601-2661
Country	:	US
Telephone Number	:	540-722-9714
Fax Number	:	540-722-9719

Provider Business Practice Location Address
First Line	:	2654 VALLEY AVE
Second Line	:	SUITE D
City	:	WINCHESTER
State	:	VA
Zip	:	22601-2661
Country	:	US
Telephone Number	:	540-722-9714
Fax Number	:	540-722-9719

Authorized Official
Title or Position	:	OWNER
Name	:	MR. RICHARD CHURCHILL I
Credential	:	CPO
Telephone Number	:	540-722-9714

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	08/26/2011

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