SOUNDSIDE ORTHOTICS & PROSTHETICS, LLC (NPI# 1902366180) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902366180 |
| Entity Type | Organization |
| Organization Name | SOUNDSIDE ORTHOTICS & PROSTHETICS, LLC |
| Other Organization Name | COASTAL PROSTHETICS & ORTHOTICS, LLC |
| Practice Address |
1715 Country Club Rd Ste B Jacksonville NC 28546-6042 |
| Practice Telephone | 9103782710 |
| Practice Fax Number | 9102382856 |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2020-10-09 |
| Authorized Official Name | STEPHEN G TRUESDALE (PRESIDENT) |
| Authorized Official Telephone | 9102382026 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332BC3200X |
Durable Medical Equipment & Medical Supplies Specialization: Customized Equipment |
Suppliers |
| Other Name | Type Code |
|---|---|
| Coastal Prosthetics & Orthotics, LLC | Former Legal Business Name - Organization |
| Street Address |
1715 COUNTRY CLUB RD STE B |
| City | JACKSONVILLE |
| State | NC |
| Zip Code | 28546-6042 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790233385 | Coastal Carolina Prosthetics & Orthotics, Inc. | Durable Medical Equipment & Medical Supplies | 1715 Country Club Rd Ste B, Jacksonville, NC 28546-6042 | 2016-09-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316578388 | Judylyn Hobson | Registered Nurse | Pride In North Carolina, LLC, 3886 Henderson Dr, Jacksonville, NC 28546 | 2020-01-29 |
| 1427694637 | Aaron Patrick Bettcher | Military Health Care Provider | 3rd Mrb Loop Rd, Camp Lejeune, NC 28546 | 2019-11-22 |
| 1962044289 | Levi Scott Marshall | Military Health Care Provider | Everett Creek Road, Building 612, Camp Lejeune, NC 28546 | 2019-10-09 |
| 1649826652 | Nicholas Otazo | Military Health Care Provider | 3rd Mrb 20073, Camp Lejeune, NC 28546 | 2019-08-15 |
| 1417519570 | Publix North Carolina, Lp | Durable Medical Equipment & Medical Supplies | 2001 Marlin Drive Unit 100, Jacksonville, NC 28546 | 2019-06-28 |
| 1023500212 | Josip Ninrodriguez | Military Health Care Provider | 3d Marine Raider Battaliom, Camp Lejeune, NC 28546 | 2018-06-04 |
| 1639661192 | Kenneth Lee Russell | Military Health Care Provider | 3d Marine Raider Battalion, Camp Lejeune, NC 28546 | 2018-05-31 |
| 1346730173 | Coastal Foot Center, LLC | Clinic/Center | 29 Office Park Dr Ste B, Jacksonville, NC 28546 | 2018-05-17 |
| 1578080271 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 380 Western Blvd, Jacksonville, NC 28546 | 2017-08-24 |
| 1144757493 | Darin Lee Peterson | Specialist/Technologist | G644 Camp Geiger, School of Infantry-east, Jacksonville, NC 28546 | 2017-05-17 |
| Find all providers in zip 28546 | ||||
| Taxonomy Code | 332BC3200X |
| Grouping | Suppliers |
| Classification | Durable Medical Equipment & Medical Supplies |
| Specialization | Customized Equipment |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407318397 | Universal Design Solutions LLC | Durable Medical Equipment & Medical Supplies | 11555 Central Pkwy Ste 1002, Jacksonville, FL 32224-2702 | 2019-04-01 |
| 1700311065 | National Seating & Mobility, Inc | Durable Medical Equipment & Medical Supplies | 11651 Central Pkwy Ste 121, Jacksonville, FL 32224-2709 | 2017-04-25 |
| 1790233385 | Coastal Carolina Prosthetics & Orthotics, Inc. | Durable Medical Equipment & Medical Supplies | 1715 Country Club Rd Ste B, Jacksonville, NC 28546-6042 | 2016-09-13 |
| 1548500911 | Wayne's 1/2 Price Bedding | Durable Medical Equipment & Medical Supplies | 5853 Normandy Blvd, Jacksonville, FL 32205-6252 | 2013-02-22 |
| 1881992030 | Kobe Ellis | Durable Medical Equipment & Medical Supplies | 3745 Southside Blvd, Jacksonville, FL 32216-4637 | 2011-03-10 |
| 1598062978 | Mitchell R Levine Dmd Pa | Durable Medical Equipment & Medical Supplies | 3600 Cardinal Point Dr, Jacksonville, FL 32257-5581 | 2011-02-20 |
| 1689983397 | Menrx Surgical, LLC | Durable Medical Equipment & Medical Supplies | 10302 Deerwood Park Blvd, Suite 209, Jacksonville, FL 32256-2880 | 2010-09-29 |
| 1447586466 | Wng LLC | Durable Medical Equipment & Medical Supplies | 7667 W Beaver St Lot 5, Jacksonville, FL 32220-3601 | 2009-10-27 |
| 1134249410 | Mandarin Eyecare Assoc, Inc | Durable Medical Equipment & Medical Supplies | 11111 San Jose Blvd, Suite 44, Jacksonville, FL 32223-7946 | 2007-03-30 |
| 1720007610 | Realo Discount Drug Stores of Eastern North Carolina, Inc. | Durable Medical Equipment & Medical Supplies | 2680 Henderson Dr, Unit 1, Jacksonville, NC 28546-5296 | 2006-07-19 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 28546 |
Please comment or provide details below to improve the information on SOUNDSIDE ORTHOTICS & PROSTHETICS, LLC.
| 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.