MEDICARE: ALBEMARLE 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	224P00000X	Prosthetist
2	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1912437930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALBEMARLE ORTHOTICS & PROSTHETICS, INC

Provider Business Mailing Address
First Line	:	106 MEDICAL DR
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-3361
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1970 W ARLINGTON BLVD STE A
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-5783
Country	:	US
Telephone Number	:	252-378-9770
Fax Number	:	252-378-9880

Authorized Official
Title or Position	:	OWNER
Name	:	KIMBERLY S WILLIAMSON
Credential	:	CPO
Telephone Number	:	252-338-3002

Provider Enumeration Date	:	06/13/2017
Last Update Date	:	12/09/2020

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