Provider Demographics
NPI:1710221197
Name:WESTERN CAROLINA O & P
Entity type:Organization
Organization Name:WESTERN CAROLINA O & P
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WIGGEN
Authorized Official - Suffix:
Authorized Official - Credentials:COF
Authorized Official - Phone:828-595-9371
Mailing Address - Street 1:107 EAST WALKER STREET
Mailing Address - Street 2:
Mailing Address - City:EAST FLAT ROCK
Mailing Address - State:NC
Mailing Address - Zip Code:28726
Mailing Address - Country:US
Mailing Address - Phone:828-595-9371
Mailing Address - Fax:828-595-9373
Practice Address - Street 1:107 E WALKER ST
Practice Address - Street 2:
Practice Address - City:EAST FLAT ROCK
Practice Address - State:NC
Practice Address - Zip Code:28726-2235
Practice Address - Country:US
Practice Address - Phone:828-595-9371
Practice Address - Fax:828-595-9373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7200591Medicaid
NC6725350001Medicare NSC
SCDE3482Medicaid