MEDICARE: CENTER FOR ORTHOTIC AND PROSTHETIC CARE OF NORTH CAROLINA, INC.

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		NY

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

General Provider Information

NPI Number	:	1700185238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR ORTHOTIC AND PROSTHETIC CARE OF NORTH CAROLINA, INC.

Provider Business Mailing Address
First Line	:	130 OAKDALE RD
Second Line	:
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-1758
Country	:	US
Telephone Number	:	607-235-3066
Fax Number	:	607-235-3068

Provider Business Practice Location Address
First Line	:	130 OAKDALE RD
Second Line	:
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-1758
Country	:	US
Telephone Number	:	607-235-3066
Fax Number	:	607-235-3068

Authorized Official
Title or Position	:	REG COMPLIANCE SPECIALIST III
Name	:	GRACE ANGELINE
Credential	:
Telephone Number	:	714-961-2102

Provider Enumeration Date	:	03/23/2011
Last Update Date	:	02/10/2019

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