Provider Demographics
NPI:1427136845
Name:NORTH CAROLINA ORTHOTICS & PROSTHETICS
Entity type:Organization
Organization Name:NORTH CAROLINA ORTHOTICS & PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNCOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-556-3402
Mailing Address - Street 1:451 RUIN CREEK RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-2878
Mailing Address - Country:US
Mailing Address - Phone:252-436-2611
Mailing Address - Fax:252-436-2640
Practice Address - Street 1:451 RUIN CREEK RD
Practice Address - Street 2:SUITE 102
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-2878
Practice Address - Country:US
Practice Address - Phone:252-436-2611
Practice Address - Fax:252-436-2640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7703875Medicaid
NC046KYOtherBLUE CROSS & BLUE SHIELD
NC4830690001Medicare NSC
NC4830690001Medicare PIN