1023009867 NPI number — PROSTHETIC LABORATORIES OF ROCHESTER INC

Table of content: DR. SCOTT TORRES DONA MD (NPI 1659867810)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023009867 NPI number — PROSTHETIC LABORATORIES OF ROCHESTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROSTHETIC LABORATORIES OF ROCHESTER 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:
1023009867
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1517 N OAK AVE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
MARSHFIELD
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54449-1301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-384-8030
Provider Business Mailing Address Fax Number:
715-384-7818

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1517 N OAK AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
MARSHFIELD
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54449-1301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-384-8030
Provider Business Practice Location Address Fax Number:
715-384-7818
Provider Enumeration Date:
11/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LACEY
Authorized Official First Name:
RANDY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
507-281-5250

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: 41790900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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