MEDICARE: CAPE FEAR 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

General Provider Information

NPI Number	:	1992015457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPE FEAR ORTHOTICS & PROSTHETICS, INC.

Provider Business Mailing Address
First Line	:	PO BOX 58611
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28305-8611
Country	:	US
Telephone Number	:	910-483-0933
Fax Number	:	910-483-9622

Provider Business Practice Location Address
First Line	:	2100 OLD HIGHWAY 17 N
Second Line	:	SUITE 102
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-2242
Country	:	US
Telephone Number	:	843-249-2500
Fax Number	:	843-249-2544

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. DIMITRI K SLEEM
Credential	:
Telephone Number	:	910-485-5811

Provider Enumeration Date	:	10/18/2010
Last Update Date	:	04/25/2012

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