1124082433 NPI number — KNAPP PROSTHETICS

Table of content: (NPI 1124082433)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124082433 NPI number — KNAPP PROSTHETICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KNAPP 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:
SOUND PROSTHETICS & ORTHOTICS, INC.
Provider Other Organization Name Type Code:
3
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:
1124082433
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
530 LILLY RD SE
Provider Second Line Business Mailing Address:
#100
Provider Business Mailing Address City Name:
OLYMPIA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98501-2111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-486-0565
Provider Business Mailing Address Fax Number:
360-486-0551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
530 LILLY RD SE
Provider Second Line Business Practice Location Address:
#100
Provider Business Practice Location Address City Name:
OLYMPIA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98501-2111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-486-0565
Provider Business Practice Location Address Fax Number:
360-486-0551
Provider Enumeration Date:
04/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KNAPP
Authorized Official First Name:
GARTH
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
360-486-0565

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , with the licence number:  PS00000379 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X , with the licence number: OI00000186 , 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: 188631 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 9055971 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1255SO . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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