1154328078 NPI number — ORTHO-TEC MEDICAL, INC.

Table of content: (NPI 1154328078)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154328078 NPI number — ORTHO-TEC MEDICAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHO-TEC MEDICAL, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154328078
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 364
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEBSTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01570-0364
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-616-9811
Provider Business Mailing Address Fax Number:
888-616-9812

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 GORE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEBSTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01570-6834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-616-9811
Provider Business Practice Location Address Fax Number:
888-616-9812
Provider Enumeration Date:
07/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HAYNES
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
888-616-9811

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1154328078 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1537172 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5830001 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 604729 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1154328078 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 003107936 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 370854 . This is a "BCBS OF MASSACHUSETTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1154328078 . This is a "HPHC INSURANCE COMPANY" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 42008 . This is a "FALLON COMMUNITY HEALTH P" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8200076 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".




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