ISAAC JAMES KOLODITCH
NPI 1174191399
Student in an Organized Health Care Education/Training Program in Winston Salem, NC

Active since June 14, 2021PECOS Enrolled
475 VINE ST, WINSTON SALEM, NC 27101(941) 761-0409 Get Directions Write a Review

NPPES record last updated: June 14, 2021. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Isaac James Koloditch NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ISAAC JAMES KOLODITCH (NPI 1174191399) is an individual student in an organized health care education/training program in Winston Salem, North Carolina and active in the NPI registry since June 2021. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1174191399
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameISAAC JAMES KOLODITCH
Location Address475 VINE STWinston Salem, NC 27101-4135
Mailing Address912 Madison AveWinston Salem, NC 27103-4542 · (941) 716-0409
Sole ProprietorYes
Enumeration DateJune 14, 2021
NPPES CertifiedJune 14, 2021
NPI 1174191399 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Taxonomy Code390200000X
Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

475 VINE ST, Winston Salem, NC 27101

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare (PECOS)

Isaac James Koloditch is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 14

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Student in an Organized Health Care Education/Training Program
475 VINE ST
WINSTON SALEM, NC 27101
Student in an Organized Health Care Education/Training Program
475 VINE ST
WINSTON SALEM, NC 27101
Student in an Organized Health Care Education/Training Program
475 VINE ST
WINSTON SALEM, NC 27101
Student in an Organized Health Care Education/Training Program
475 VINE ST
WINSTON SALEM, NC 27101
Student in an Organized Health Care Education/Training Program
475 VINE ST
WINSTON SALEM, NC 27101
Student in an Organized Health Care Education/Training Program
475 VINE ST
WINSTON SALEM, NC 27101
Student in an Organized Health Care Education/Training Program
475 VINE ST
WINSTON SALEM, NC 27101
Student in an Organized Health Care Education/Training Program
475 VINE ST
WINSTON SALEM, NC 27101

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1174191399, enumerated as an "individual" on June 14, 2021.

The provider is located at 475 VINE ST WINSTON SALEM, NC 27101 and the phone number is (941) 761-0409.

Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.