1295889053 NPI number — CORNERSTONE PROSTHETICS AND ORTHOTICS, INC

Table of content: (NPI 1295889053)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295889053 NPI number — CORNERSTONE PROSTHETICS AND ORTHOTICS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORNERSTONE PROSTHETICS AND ORTHOTICS, 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:
1295889053
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 44TH ST SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVERETT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98203-2200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-339-2559
Provider Business Mailing Address Fax Number:
425-339-1583

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3106 NORTHWEST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98225-1608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-734-0298
Provider Business Practice Location Address Fax Number:
360-734-9679
Provider Enumeration Date:
01/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HUGHES
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
425-339-2559

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , with the licence number:  600596756 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9018516 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9004717 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 91118 . This is a "LABOR AND INDUSTRIES -P&O" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: CO7974 . This is a "REGENCE - P & O" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 192166200 . This is a "OWCP - P & O" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2006747 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 027038001 . This is a "GROUP HEALTH - P & O" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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