COUNTRY COBBLER, LTD. (NPI# 1780646653) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780646653 |
| Entity Type | Organization |
| Organization Name | COUNTRY COBBLER, LTD. |
| Practice Address |
3501 Oleander Dr Suite 11 Wilmington NC 28403-0824 |
| Practice Telephone | 9107729994 |
| Practice Fax Number | 9107721262 |
| Mailing Telephone | 9107729994 |
| Mailing Fax Number | 9107721262 |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2015-09-18 |
| Authorized Official Name | MR. MARK ALLEN MANTEY (DIABETIC SHOE PROGRAM FACILITATOR) |
| Authorized Official Telephone | 9107729994 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 335E00000X | Prosthetic/Orthotic Supplier | 00992 | NC | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 7704409 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255681797 | Country Cobbler, Ltd. | Prosthetic/Orthotic Supplier | 6815 Fayetteville Road, #102, Durham, NC 27713-7081 | 2012-09-12 |
| 1962758714 | Country Cobbler, Ltd. | Prosthetic/Orthotic Supplier | 1001 Airport Blvd, Suite 125, Morrisville, NC 27560-8935 | 2012-07-31 |
| 1821344706 | Country Cobbler, Ltd. | Prosthetic/Orthotic Supplier | 255 N Equity Dr Ste A, Smithfield, NC 27577-6054 | 2012-07-30 |
| Street Address |
3501 OLEANDER DR SUITE 11 |
| City | WILMINGTON |
| State | NC |
| Zip Code | 28403-0824 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275052185 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 3501 Oleander Dr, Wilmington, NC 28403-0864 | 2017-09-12 |
| 1528586492 | Walgreen Co | Pharmacy | 3501 Oleander Dr, Hanover Center, Wilmington, NC 28403-0864 | 2017-08-31 |
| 1073812855 | Michael Lindsay Allred | Pharmacist | 3501 Oleander Dr, Wilmington, NC 28403-0864 | 2011-03-20 |
| 1891927166 | Joseph Crockett Shaffer II | Pharmacist | 3501 Oleander Dr, Wilmington, NC 28403 | 2009-08-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902413875 | Ymca of Southeastern Nc | Health Educator | 2710 Market Street, Wilmington, NC 28403 | 2020-09-25 |
| 1659917334 | Noa Alper | Occupational Therapist | 5412 Old Garden Road, Wilmington, NC 28403 | 2019-11-18 |
| 1992346340 | Nancy Rosita Carson | Technician | 5608 Locke Str. Apt 108, Wilmington, NC 28403 | 2019-10-07 |
| 1912484585 | Jennifer Nicole Perry | Behavior Technician | 349 Campus Cv, Wilmington, NC 28403 | 2018-07-25 |
| 1386159929 | Monumental Foundations LLC | Clinic/Center | Plum Tree Plaza 925 South Kerr Ave Suite F4, Wilmington, NC 28403 | 2017-12-05 |
| 1114445731 | Jacqulyn Craichy | Speech-Language Pathologist | 75 Cavalier Drive, Wilmington, NC 28403 | 2017-09-04 |
| 1730638545 | Ashley Mcneil | Durable Medical Equipment & Medical Supplies | 3435 Wilshire Blvd Apt 203, Wilmington, NC 28403 | 2016-09-22 |
| 1306204276 | Valerie Pringle Jones | Physical Therapist | 1717 Shipyard Blvd. Ste 350, Wilmington, NC 28403 | 2016-02-05 |
| 1689039992 | Lifeline Treatment Center | Clinic/Center | 5710 Oleander Dr Ste 100, Wilmington, NC 28403 | 2015-12-31 |
| 1750758264 | Melissa Beatson | Speech-Language Pathologist | 4014 Oleander Drive, Ste. 3b, Coastal Speech & Language Pllc, Wilmington, NC 28403 | 2015-09-01 |
| Find all providers in zip 28403 | ||||
| Taxonomy Code | 335E00000X |
| Grouping | Suppliers |
| Classification | Prosthetic/Orthotic Supplier |
| An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316585789 | Orthologix, LLC | Prosthetic/Orthotic Supplier | 2700 Silverside Rd Ste 5a, Wilmington, DE 19810-3724 | 2019-12-17 |
| 1699024489 | Genesis Diabetic Shoes & Medical Supplies | Prosthetic/Orthotic Supplier | 3806 1/2 Park Ave, Wilmington, NC 28403-6756 | 2012-09-07 |
| 1437450293 | Mid Atlantic Prosthetics and Orthotics North | Prosthetic/Orthotic Supplier | 2604 Kirkwood Hwy, Suite C, Wilmington, DE 19805-4910 | 2010-11-10 |
| 1750601944 | Adaptive Technologies, LLC | Prosthetic/Orthotic Supplier | 1960 South 17th Street, Suite 201, Wilmington, NC 28401 | 2010-06-10 |
| 1992938757 | Tracy Lynn Johnson | Prosthetic/Orthotic Supplier | 2309 S 17th St Ste 100, Wilmington, NC 28401-8006 | 2009-08-27 |
| 1811128242 | Delaware Pedorthics | Prosthetic/Orthotic Supplier | 5321 Brandywine Pkwy, Wilmington, DE 19803-1471 | 2009-08-03 |
| 1851448419 | Floyds Braces & Limbs | Prosthetic/Orthotic Supplier | 1880 S 17th St, Wilmington, NC 28401-6444 | 2007-01-05 |
| 1669472692 | Lawall Prosthetic/orthotics, Inc. | Prosthetic/Orthotic Supplier | 1822 Augustine Cut Off, Wilmington, DE 19803-4405 | 2005-08-01 |
| 1710344304 | Coastal Carolina Prosthetics & Orthotics, Inc. | Prosthetic/Orthotic Supplier | 2800 Ashton Dr Ste 201, Wilmington, NC 28412-2486 | 2016-01-27 |
| 1518343482 | Balance Prosthetics and Orthotics Inc | Prosthetic/Orthotic Supplier | 2604 Kirkwood Hwy, Unit C, Wilmington, DE 19805-4910 | 2015-08-03 |
| Find all providers in WILMINGTON | ||||
| City | WILMINGTON |
| Zip Code | 28403 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.