THE CUSTOM SOURCE INC (NPI# 1114902665) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114902665 |
| Entity Type | Organization |
| Organization Name | THE CUSTOM SOURCE INC |
| Practice Address |
1013 Chestnut Ln Ste 120 Matthews NC 28104-8567 |
| Practice Telephone | (704) 893-5457 |
| Practice Fax Number | 7049730696 |
| Mailing Telephone | (704) 893-5457 |
| Mailing Fax Number | 7049730696 |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2017-09-25 |
| Authorized Official Name | KASEY ROLFES (OPERATIONS MANAGER) |
| Authorized Official Telephone | 7048935457 |
| Authorized Official Credential | DHA, ATC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 222Z00000X | Orthotist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 335E00000X | Prosthetic/Orthotic Supplier | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| BC/BS/NC | 0491E | 01 | |
| NC | 7700578 | 05 |
| Street Address |
1013 CHESTNUT LN STE 120 |
| City | MATTHEWS |
| State | NC |
| Zip Code | 28104-8567 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407848070 | Thomas J Morgan | Specialist/Technologist | 1013 Chestnut Ln Ste 120, Matthews, NC 28104 | 2005-08-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962038133 | Robert Anthony Baldinell | Behavior Technician | 4224 Weddington Matthews Rd, Wedding, NC 28104 | 2020-03-19 |
| 1740841972 | Jennifer Louise Lowder | Occupational Therapist | 3653 Huntington Drive, Matthews, NC 28104 | 2019-06-27 |
| 1669954608 | Novant Medical Group, Inc. | Family Medicine | 6488 Weddington-monroe, Wesley Chapel, NC 28104 | 2018-09-06 |
| 1427565704 | Hiren Patel D.m.d. II, Pa | Clinic/Center | 2925 Matthews Weddington Road, Suite 200, Matthews, NC 28104 | 2018-01-08 |
| 1073069274 | Amie Freeman | Pharmacist | 6300 Weddington-monroe Rd, Matthews, NC 28104 | 2016-08-28 |
| 1568819928 | Katelyn Koch | Behavioral Analyst | 4225 Weddington Matthews Road, Weddington, NC 28104 | 2016-05-16 |
| 1396103958 | Kristen Smith | Advanced Practice Midwife | 6488 Weddington Monroe Rd, Wesley Chapel, NC 28104 | 2016-02-10 |
| 1407226137 | Ulla Svane Chiropractic Pllc | Clinic/Center | 13635 Providence Road, Weddington, NC 28104 | 2015-10-07 |
| 1699159392 | Anait Balasanyan | Dentist | 5922 Weddington-monroe Rd., Ste A-2, Wesley Chapel, NC 28104 | 2015-07-13 |
| 1780082461 | Balasanyan & Associates Pllc | Dentist | 5922 Weddington-monroe Rd, Suite A2, Wesley Chapel, NC 28104 | 2014-12-12 |
| Find all providers in zip 28104 | ||||
| Taxonomy Code | 335E00000X |
| Grouping | Suppliers |
| Classification | Prosthetic/Orthotic Supplier |
| An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275616211 | Prosthetic Orthotic Care Center,inc | Prosthetic/Orthotic Supplier | 1352 Matthews Township Pkwy Ste 101, Matthews, NC 28105-4985 | 2006-10-23 |
| 1336193754 | Liberty Healthcare Group LLC | Prosthetic/Orthotic Supplier | 2700 Royal Commons Ln, Matthews, NC 28105-2890 | 2006-05-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659970770 | Survivor Friendly LLC | Prosthetic/Orthotic Supplier | 527 Keisler Dr Ste 104, Cary, NC 27518-9306 | 2020-10-20 |
| 1154920395 | Anderson Prosthetics & Orthotics, LLC | Prosthetic/Orthotic Supplier | 307 W Tremont Ave Ste 200, Charlotte, NC 28203-4902 | 2020-10-20 |
| 1528666195 | Skyland Prosthetics & Orthotics Inc | Prosthetic/Orthotic Supplier | 1141 Tunnel Rd Ste E, Asheville, NC 28805-2037 | 2020-10-15 |
| 1982202545 | Davidson Prosthetics & Orthotics | Prosthetic/Orthotic Supplier | 845 Church St N Ste 205, Concord, NC 28025-4374 | 2020-10-15 |
| 1891301156 | Tys Cranial Prothesis | Prosthetic/Orthotic Supplier | 2400 S Memorial Dr Ste 3b, Greenville, NC 27834-5031 | 2020-09-21 |
| 1124645882 | The Royal Stich By Melinda | Prosthetic/Orthotic Supplier | 8032 Black Forest Ln Apt 10103, Charlotte, NC 28277-6746 | 2020-06-29 |
| 1073134573 | Diva Salon By Veronica Ashley, Inc. | Prosthetic/Orthotic Supplier | 10901 University City Blvd Ste 108, Charlotte, NC 28213-9300 | 2020-05-06 |
| 1841819711 | Sc&f Enterprises, LLC | Prosthetic/Orthotic Supplier | 2187 Skibo Rd, Fayetteville, NC 28314-0264 | 2020-04-10 |
| 1457986499 | Lala Lashes Charlotte | Prosthetic/Orthotic Supplier | 2434 Shad Ct, Charlotte, NC 28208-3307 | 2020-03-10 |
| 1871125237 | Elite Hair Replacement Inc | Prosthetic/Orthotic Supplier | 2110 Fort Bragg Rd Ste 112, Fayetteville, NC 28303-7036 | 2020-02-04 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on THE CUSTOM SOURCE 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.