Provider Demographics
NPI:1124122726
Name:ORTHO PROS EXPRESS
Entity type:Organization
Organization Name:ORTHO PROS EXPRESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:F
Authorized Official - Last Name:TRIMNAL
Authorized Official - Suffix:
Authorized Official - Credentials:DME
Authorized Official - Phone:704-921-2286
Mailing Address - Street 1:PO BOX 26828
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28221-6828
Mailing Address - Country:US
Mailing Address - Phone:704-921-2286
Mailing Address - Fax:704-921-2287
Practice Address - Street 1:2205 DISTRIBUTION CENTER DR STE A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-4283
Practice Address - Country:US
Practice Address - Phone:704-921-2286
Practice Address - Fax:704-921-2287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0395AOtherBLUE CROSS BLUE SHIELD
NC7701803Medicaid
SCDME958Medicaid
VA282056OtherANTHEM BCBS
VA91-1373-8Medicaid
NC1038990001Medicare ID - Type Unspecified