MEDICARE: LEVEL FOUR ORTHOTICS & PROSTHETICS, 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

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	LEVE9603-003	OTHER	NC	LINKIA
4	0340W	OTHER	NC	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1861456691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEVEL FOUR ORTHOTICS & PROSTHETICS, INC.

Provider Business Mailing Address
First Line	:	2534 EMPIRE DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-6710
Country	:	US
Telephone Number	:	336-397-2165
Fax Number	:	336-397-2167

Provider Business Practice Location Address
First Line	:	715 FAIRGROVE CHURCH RD SE
Second Line	:	SUITE 203
City	:	CONOVER
State	:	NC
Zip	:	28613-9290
Country	:	US
Telephone Number	:	828-328-5347
Fax Number	:	828-328-4405

Authorized Official
Title or Position	:	DIRECTOR, CONTRACTING
Name	:	JANET WOODALL
Credential	:
Telephone Number	:	336-397-0993

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	07/23/2019

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Directions to “LEVEL FOUR ORTHOTICS & PROSTHETICS, INC. ” Practice Location

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