MR. RICHARD SHANE COLTRAIN (NPI# 1417994500) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417994500 |
| Entity Type | Individual |
| Full Name | MR. RICHARD SHANE COLTRAIN |
| Credential | CPO |
| Practice Address |
1025 Wh Smith Blvd Suite 108 Greenville NC 27834-5052 |
| Practice Telephone | 2522152215 |
| Practice Fax Number | 2522152216 |
| Mailing Telephone | 2522152215 |
| Mailing Fax Number | 2522152216 |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2013-04-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 222Z00000X | Orthotist | CPO 2469 | VA | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Y | 224P00000X | Prosthetist | CPO 2469 | VA | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | NC BCBS PROVIDER# | 0464J | 01 |
| NC | 7795272 | 05 | |
| NC | INDIVIDUAL ABC CERTIFICATION# | ABC CPO 2469 | 01 |
| Street Address |
1025 WH SMITH BLVD SUITE 108 |
| City | GREENVILLE |
| State | NC |
| Zip Code | 27834-5052 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790736379 | Orthotics & Prosthetics East Inc | Durable Medical Equipment & Medical Supplies | 1025 Wh Smith Blvd, Suite 108, Greenville, NC 27834-5052 | 2006-05-16 |
| 1912396052 | Garry Ogilvie | Orthotist | 1025 Wh Smith Blvd, Suite 108, Greenville, NC 27834-5199 | 2015-01-13 |
| 1033451042 | Penny C Tripp | Pedorthist | 1025 Wh Smith Blvd, Suite 108, Greenville, NC 27834-5052 | 2013-03-18 |
| 1306163860 | Randy L Daniel | Orthotist | 1025 Wh Smith Blvd, Suite 108, Greenville, NC 27834-5052 | 2010-04-23 |
| 1689798522 | Timothy Bruce Foster | Orthotist | 1025 Wh Smith Blvd, Suite 108, Greenville, NC 27834-5052 | 2007-03-17 |
| 1831200757 | Myriam M Daniel | Internal Medicine | 1025 Wh Smith Blvd, 106, Greenville, NC 27834-5199 | 2006-08-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841801255 | Nicholas Mcarthur Bennett | Day Training, Developmentally Disabled Services | 302 C, Greenville, NC 27834 | 2020-08-11 |
| 1275150245 | Shelby Renee Jones | Student in an Organized Health Care Education/Training Program | East Carolina University College of Nursing, 600 Moye Blvd, Greenville, NC 27834 | 2020-06-25 |
| 1194347138 | Soban Ahmad | Student in an Organized Health Care Education/Training Program | 600 Moye Blvd., Vmc Ma Room 350. Internal Medicine Resi, Mailstop #734, Greenville, NC 27834 | 2020-05-13 |
| 1427687789 | Brandon Allen Yates | Student in an Organized Health Care Education/Training Program | 435 Clinic Drive, Greenville, NC 27834 | 2020-04-07 |
| 1144854407 | Kristen Springer Dreyfus | Marriage & Family Therapist | 2609 West Arlington Blvd Suite 106, Greenville, NC 27834 | 2020-02-26 |
| 1861038606 | Southern Surgical Outpatient Surgery Center, Pa | Clinic/Center | 2457 Emerald Place, Greenville, NC 27834 | 2019-11-26 |
| 1003460569 | Shaun Fitzpatrick | Nurse Practitioner | Physicians East, Pa 1850 W. Arlington Blvd., Greenville, NC 27834 | 2019-08-01 |
| 1649831496 | Katherine Salome Ross | Genetic Counselor, MS | 524 Moye Blvd, Greenville, NC 27834 | 2019-06-24 |
| 1477011880 | Lauren Bethune Scroggs | Counselor | 2150 West 5th Street, Health Sciences Building Mailstop 688, Greenville, NC 27834 | 2019-03-05 |
| 1669998001 | Idella's Care Home | Community/Behavioral Health | 2912 Lee Ct # 9a, Greenville, NC 27834 | 2017-08-17 |
| Find all providers in zip 27834 | ||||
| Taxonomy Code | 224P00000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Prosthetist |
| A health care professional who is specifically educated and trained to manage comprehensive prosthetic patient care for individuals who have sustained complete or partial limb loss or absence. Prosthetists assess specific patient needs, formulate an appropriate treatment plan, implement the treatment plan and provide follow-up care. |
| 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 |
|---|---|---|---|---|
| 1912437930 | Coastal Carolina Prosthetics & Orthotics, Inc. | Prosthetist | 1970 W Arlington Blvd Ste A, Greenville, NC 27834-5783 | 2017-06-13 |
| 1164963278 | Travis Petersen | Prosthetist | 835 Johns Hopkins Dr, Suite B, Greenville, NC 27834-7268 | 2017-03-09 |
| 1114486529 | Clarissa Rose | Prosthetist | 950 W Faris Rd, Greenville, SC 29605-4255 | 2019-03-15 |
| 1528572005 | Braden D Teller | Prosthetist | 1025 Wh Smith Blvd Ste 108, Greenville, NC 27834-5278 | 2017-11-20 |
| 1275807174 | Brian Kaluf | Prosthetist | 10 Enterprise Blvd, Suite 206, Greenville, SC 29615-6301 | 2012-02-24 |
| 1649558990 | Brian Mcveigh | Prosthetist | 835 Johns Hopkins Dr Ste B, Greenville, NC 27834-7268 | 2011-08-03 |
| 1295990745 | Steven Joseph Keeton | Prosthetist | 835 Johns Hopkins Dr Ste B, Greenville, NC 27834-7268 | 2008-07-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639782857 | Ashley Brooks | Prosthetist | 2232 Page Rd Ste 104, Durham, NC 27703-7724 | 2020-08-27 |
| 1689282865 | Marquetta L Thomas | Prosthetist | 2203 Southern Ave, Fayetteville, NC 28306-2257 | 2020-07-14 |
| 1053943381 | Ashley K Sorrell | Prosthetist | 24 Wood Lake Dr, Fuquay Varina, NC 27526-4936 | 2020-02-05 |
| 1134764459 | Zachary Roggow | Prosthetist | 3400 Executive Dr Ste 102, Raleigh, NC 27609-7476 | 2019-11-11 |
| 1356990022 | Porshai Juanice Jackson | Prosthetist | 6341 Derryfield Dr, Charlotte, NC 28213-5532 | 2019-09-05 |
| 1164079117 | Sherronda Yancey | Prosthetist | 513 Yadkin St, Henderson, NC 27536-3524 | 2019-08-23 |
| 1962058909 | Tishma Mcgarrell | Prosthetist | 102 N B Street, Bridgeton, NC 28519-2851 | 2019-08-15 |
| 1306400759 | Pure Gold Luxz Hair Beauty Luxury | Prosthetist | 508 Owen Dr, Fayetteville, NC 28304-3417 | 2019-04-30 |
| 1437712601 | Anitra Nash Phifer | Prosthetist | 2483 E Ozark Ave, Gastonia, NC 28054-1421 | 2019-04-15 |
| 1881257046 | Sonja Allen | Prosthetist | 3509 David Cox Rd, Charlotte, NC 28269-2281 | 2019-04-15 |
| Find all providers with the same taxonomy | ||||
| City | GREENVILLE |
| Zip Code | 27834 |
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| 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.