Active NPI
Clover Marjorie Colonel, R.N.
- Prosthetic/Orthotic Supplier
- Burlington, NC
National Provider Identifier
1831346964
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetic/Orthotic Supplier
- Practice address
- 1040 S Church St
Burlington, NC 27215-5046 - Phone
- (336) 222-8052
- Fax
- (336) 222-8091
- NPI assigned
- Aug 20, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthotic Fitter | 225000000X | |||
| Prosthetic/Orthotic Supplier | 335E00000X | NC | Primary |
Addresses
Primary practice location
1040 S Church St
Burlington, NC 27215-5046
Mailing address
1040 S Church St
Burlington, NC 27215-5046
Phone (336) 222-8052
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7795167 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clover Family Corp | Prosthetic/Orthotic Supplier | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Durable Medical Equipment & Medical Supplies
- Burlington, NC
- NPI 1306825005
Prosthetic/Orthotic Supplier
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571961600000",
"number": "1831346964",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1040 S CHURCH ST",
"city": "BURLINGTON",
"state": "NC",
"postal_code": "272155046",
"telephone_number": "336-222-8052",
"fax_number": "336-222-8091"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1040 S CHURCH ST",
"city": "BURLINGTON",
"state": "NC",
"postal_code": "272155046",
"telephone_number": "336-222-8052",
"fax_number": "336-222-8091"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLONEL",
"first_name": "CLOVER",
"middle_name": "MARJORIE",
"credential": "R.N.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-08-20",
"last_updated": "2019-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "225000000X",
"taxonomy_group": "",
"desc": "Orthotic Fitter",
"state": null,
"license": null,
"primary": false
},
{
"code": "335E00000X",
"taxonomy_group": "",
"desc": "Prosthetic/Orthotic Supplier",
"state": "NC",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7795167",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Burlington, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.