Provider Demographics
NPI:1912437930
Name:ALBEMARLE ORTHOTICS & PROSTHETICS, INC
Entity type:Organization
Organization Name:ALBEMARLE ORTHOTICS & PROSTHETICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:252-338-3002
Mailing Address - Street 1:106 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3361
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1970 W ARLINGTON BLVD STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5783
Practice Address - Country:US
Practice Address - Phone:252-378-9770
Practice Address - Fax:252-378-9880
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALBEMARLE ORTHOTICS & PROSTHETICS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-13
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty