MEDICARE: WESTERN CAROLINA O & P

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
2	332BC3200X	Customized Equipment (DME)

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	:	1710221197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN CAROLINA O & P

Provider Business Mailing Address
First Line	:	107 EAST WALKER STREET
Second Line	:
City	:	EAST FLAT ROCK
State	:	NC
Zip	:	28726
Country	:	US
Telephone Number	:	828-595-9371
Fax Number	:	828-595-9373

Provider Business Practice Location Address
First Line	:	107 E WALKER ST
Second Line	:
City	:	EAST FLAT ROCK
State	:	NC
Zip	:	28726-2235
Country	:	US
Telephone Number	:	828-595-9371
Fax Number	:	828-595-9373

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MRS. KELLY WIGGEN
Credential	:	COF
Telephone Number	:	828-595-9371

Provider Enumeration Date	:	11/26/2012
Last Update Date	:	08/27/2014

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Directions to “WESTERN CAROLINA O & P ” Practice Location

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