Basic Information
Provider Information | |||||||||
NPI: | 1154378016 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CAROLINA MOBILITY & SEATING, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1001 AMERICAN WAY | ||||||||
Address2: |   | ||||||||
City: | APEX | ||||||||
State: | NC | ||||||||
PostalCode: | 275027700 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9193030902 | ||||||||
FaxNumber: | 9193039866 | ||||||||
Practice Location | |||||||||
Address1: | 1001 AMERICAN WAY | ||||||||
Address2: |   | ||||||||
City: | APEX | ||||||||
State: | NC | ||||||||
PostalCode: | 27502 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9193030902 | ||||||||
FaxNumber: | 9193039866 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/27/2006 | ||||||||
LastUpdateDate: | 08/19/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | ELLIOTT | ||||||||
AuthorizedOfficialFirstName: | MELICK | ||||||||
AuthorizedOfficialMiddleName: | B | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT OWNER | ||||||||
AuthorizedOfficialTelephone: | 9193030902 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BC3200X | 00303 | NC | Y |   | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment |
ID Information
ID | Type | State | Issuer | Description | 7702255 | 05 | NC |   | MEDICAID |