Provider Demographics
NPI:1902801244
Name:LEVEL FOUR ORTHOTICS & PROSTHETICS, INC.
Entity Type:Organization
Organization Name:LEVEL FOUR ORTHOTICS & PROSTHETICS, INC.
Other - Org Name:RESTORE POC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-397-0993
Mailing Address - Street 1:2534 EMPIRE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6710
Mailing Address - Country:US
Mailing Address - Phone:336-397-2165
Mailing Address - Fax:336-397-2167
Practice Address - Street 1:1673 WESTBROOK PLAZA DR STE 230
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3068
Practice Address - Country:US
Practice Address - Phone:336-765-2425
Practice Address - Fax:336-765-8370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNA335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0340WOtherBCBS PROVIDER NUMBER
NC1902801244Medicaid
VAVA010052734Medicaid
NCLEVE9603-000OtherLINKIA
NC7703969Medicaid
87738OtherMULTIPLAN
VAVA010052734Medicaid