COASTAL CAROLINA PROSTHETICS & ORTHOTICS, INC. (NPI# 1790233385) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790233385 |
| Entity Type | Organization |
| Organization Name | COASTAL CAROLINA PROSTHETICS & ORTHOTICS, INC. |
| Other Organization Name | COASTAL CAROLINA PROSTHETICS & ORTHOTICS |
| Practice Address |
1715 Country Club Rd Ste B Jacksonville NC 28546-6042 |
| Mailing Address |
445 Western Blvd Suite G Jacksonville NC 28546-6845 |
| Practice Telephone | 9103782710 |
| Practice Fax Number | 9102382656 |
| Mailing Telephone | (910) 378-2710 |
| Mailing Fax Number | 9102382656 |
| Enumeration Date | 2016-09-13 |
| Last Update Date | 2017-07-21 |
| Authorized Official Name | MRS. KIMBERLY WILLIAMSON (ORTHOTIST) |
| Authorized Official Telephone | 2523383002 |
| Authorized Official Credential | CO,CPA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332BC3200X |
Durable Medical Equipment & Medical Supplies Specialization: Customized Equipment |
Suppliers |
| Other Name | Type Code |
|---|---|
| Coastal Carolina Prosthetics & Orthotics | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912437930 | Coastal Carolina Prosthetics & Orthotics, Inc. | Prosthetist | 1970 W Arlington Blvd Ste A, Greenville, NC 27834-5783 | 2017-06-13 |
| 1386842193 | Coastal Carolina Prosthetics & Orthotics, Inc. | Durable Medical Equipment & Medical Supplies | 103 Nc Highway 42 W, Ahoskie, NC 27910-9725 | 2007-07-03 |
| 1760583033 | Coastal Carolina Prosthetics & Orthotics, Inc. | Prosthetic/Orthotic Supplier | 148 Burnetts Way Ste 104, Suffolk, VA 23434-6149 | 2006-09-26 |
| 1124096292 | Coastal Carolina Prosthetics & Orthotics, Inc. | Durable Medical Equipment & Medical Supplies | 106 Medical Drive, Elizabeth City, NC 27909 | 2006-03-14 |
| 1710344304 | Coastal Carolina Prosthetics & Orthotics, Inc. | Prosthetic/Orthotic Supplier | 2800 Ashton Dr Ste 201, Wilmington, NC 28412-2486 | 2016-01-27 |
| 1659472926 | Coastal Carolina Prosthetics & Orthotics, Inc. | Durable Medical Equipment & Medical Supplies | 405 W 15th St, Washington, NC 27889-3524 | 2006-09-26 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | COASTAL CAROLINA PROSTHETICS & ORTHOTICS, INC. | 103 Nc Hwy 42 W, Ahoskie, NC 27910-9725 |
| Street Address |
1715 COUNTRY CLUB RD STE B |
| City | JACKSONVILLE |
| State | NC |
| Zip Code | 28546-6042 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902366180 | Soundside Orthotics & Prosthetics, LLC | Durable Medical Equipment & Medical Supplies | 1715 Country Club Rd Ste B, Jacksonville, NC 28546-6042 | 2019-03-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316578388 | Judylyn Hobson | Registered Nurse | Pride In North Carolina, LLC, 3886 Henderson Dr, Jacksonville, NC 28546 | 2020-01-29 |
| 1427694637 | Aaron Patrick Bettcher | Military Health Care Provider | 3rd Mrb Loop Rd, Camp Lejeune, NC 28546 | 2019-11-22 |
| 1962044289 | Levi Scott Marshall | Military Health Care Provider | Everett Creek Road, Building 612, Camp Lejeune, NC 28546 | 2019-10-09 |
| 1649826652 | Nicholas Otazo | Military Health Care Provider | 3rd Mrb 20073, Camp Lejeune, NC 28546 | 2019-08-15 |
| 1417519570 | Publix North Carolina, Lp | Durable Medical Equipment & Medical Supplies | 2001 Marlin Drive Unit 100, Jacksonville, NC 28546 | 2019-06-28 |
| 1023500212 | Josip Ninrodriguez | Military Health Care Provider | 3d Marine Raider Battaliom, Camp Lejeune, NC 28546 | 2018-06-04 |
| 1639661192 | Kenneth Lee Russell | Military Health Care Provider | 3d Marine Raider Battalion, Camp Lejeune, NC 28546 | 2018-05-31 |
| 1346730173 | Coastal Foot Center, LLC | Clinic/Center | 29 Office Park Dr Ste B, Jacksonville, NC 28546 | 2018-05-17 |
| 1578080271 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 380 Western Blvd, Jacksonville, NC 28546 | 2017-08-24 |
| 1144757493 | Darin Lee Peterson | Specialist/Technologist | G644 Camp Geiger, School of Infantry-east, Jacksonville, NC 28546 | 2017-05-17 |
| Find all providers in zip 28546 | ||||
| Taxonomy Code | 332BC3200X |
| Grouping | Suppliers |
| Classification | Durable Medical Equipment & Medical Supplies |
| Specialization | Customized Equipment |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407318397 | Universal Design Solutions LLC | Durable Medical Equipment & Medical Supplies | 11555 Central Pkwy Ste 1002, Jacksonville, FL 32224-2702 | 2019-04-01 |
| 1700311065 | National Seating & Mobility, Inc | Durable Medical Equipment & Medical Supplies | 11651 Central Pkwy Ste 121, Jacksonville, FL 32224-2709 | 2017-04-25 |
| 1548500911 | Wayne's 1/2 Price Bedding | Durable Medical Equipment & Medical Supplies | 5853 Normandy Blvd, Jacksonville, FL 32205-6252 | 2013-02-22 |
| 1881992030 | Kobe Ellis | Durable Medical Equipment & Medical Supplies | 3745 Southside Blvd, Jacksonville, FL 32216-4637 | 2011-03-10 |
| 1598062978 | Mitchell R Levine Dmd Pa | Durable Medical Equipment & Medical Supplies | 3600 Cardinal Point Dr, Jacksonville, FL 32257-5581 | 2011-02-20 |
| 1689983397 | Menrx Surgical, LLC | Durable Medical Equipment & Medical Supplies | 10302 Deerwood Park Blvd, Suite 209, Jacksonville, FL 32256-2880 | 2010-09-29 |
| 1447586466 | Wng LLC | Durable Medical Equipment & Medical Supplies | 7667 W Beaver St Lot 5, Jacksonville, FL 32220-3601 | 2009-10-27 |
| 1134249410 | Mandarin Eyecare Assoc, Inc | Durable Medical Equipment & Medical Supplies | 11111 San Jose Blvd, Suite 44, Jacksonville, FL 32223-7946 | 2007-03-30 |
| 1720007610 | Realo Discount Drug Stores of Eastern North Carolina, Inc. | Durable Medical Equipment & Medical Supplies | 2680 Henderson Dr, Unit 1, Jacksonville, NC 28546-5296 | 2006-07-19 |
| 1700856457 | Home Medical Systems Inc | Durable Medical Equipment & Medical Supplies | 13 Doris Ave E, Suite C, Jacksonville, NC 28540-5149 | 2006-01-25 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 28546 |
Please comment or provide details below to improve the information on COASTAL CAROLINA PROSTHETICS & ORTHOTICS, INC..
| 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.