1760561369 NPI number — COMMONWEALTH ORTHOTICS & PROSTHETICS

Table of content: (NPI 1760561369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760561369 NPI number — COMMONWEALTH ORTHOTICS & PROSTHETICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMONWEALTH ORTHOTICS & PROSTHETICS
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:
1760561369
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:
413 MOUNT CROSS RD
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24541-9999
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-836-4736
Provider Business Mailing Address Fax Number:
434-836-6208

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
413 MOUNT CROSS RD
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24541-9999
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-836-4736
Provider Business Practice Location Address Fax Number:
434-836-6208
Provider Enumeration Date:
11/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ARGYRAKIS
Authorized Official First Name:
THEODORE
Authorized Official Middle Name:
NICHOLAS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
434-836-4736

Provider Taxonomy Codes

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

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

  • Identifier: 009190864 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 063164 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".




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