Provider Demographics
NPI:1376830273
Name:NORTH CAROLINA ORTHOTICS & PROSTHETICS OF ROCKY MOUNT, INC
Entity type:Organization
Organization Name:NORTH CAROLINA ORTHOTICS & PROSTHETICS OF ROCKY MOUNT, INC
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 1:2717 LEIGHTON RIDGE DR
Mailing Address - Street 2:STE100
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-5987
Mailing Address - Country:US
Mailing Address - Phone:252-535-0077
Mailing Address - Fax:252-535-0078
Practice Address - Street 1:3721 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-3327
Practice Address - Country:US
Practice Address - Phone:252-210-3472
Practice Address - Fax:252-210-3473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-30
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BC3200X
NC335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7705385Medicaid
NC7705385Medicaid