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Organization
ORTHOTICS & PROSTHETICS EAST INC
Active
Organization
ORTHOTICS & PROSTHETICS EAST INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD SHANE COLTRAIN CPO (PRESIDENT)
(252) 215-2215
Entity
Organization
Contact information
Practice address
1025 WH SMITH BLVD, SUITE 108, GREENVILLE, NC 27834-5052
(252) 215-2215
(252) 215-2216
Mailing address
1025 WH SMITH BLVD, SUITE 108, GREENVILLE, NC 27834-5052
(252) 215-2215
(252) 215-2216
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BC3200X
Customized Equipment (DME)
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0464J
BCBS NC #
NC
05
—
7704508
—
NC
Enumeration date
05/16/2006
Last updated
08/04/2021
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