1992813547 NPI number — WALL PROSTHETICS & ORTHOTICS, INC

Table of content: (NPI 1992813547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992813547 NPI number — WALL PROSTHETICS & ORTHOTICS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WALL PROSTHETICS & 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:
1992813547
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 CENTENNIAL DR
Provider Second Line Business Mailing Address:
UNIT 6A
Provider Business Mailing Address City Name:
PEABODY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01960-7911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-538-9800
Provider Business Mailing Address Fax Number:
978-538-9811

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 CENTENNIAL DR
Provider Second Line Business Practice Location Address:
UNIT 6A
Provider Business Practice Location Address City Name:
PEABODY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01960-7911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-538-9800
Provider Business Practice Location Address Fax Number:
978-538-9811
Provider Enumeration Date:
08/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WALL
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
ARTHUR
Authorized Official Title or Position:
PRESIDENT/ PROSTHETIST/ ORTHOTIST
Authorized Official Telephone Number:
978-745-3500

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: 704517 . This is a "HPHC ORTHOTICS/ PROSTHET" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 685834 . This is a "TUFTS ORTHOTICS/ PROSTHET" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 986834 . This is a "NETWORK HEALTH O & P" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 392254 . This is a "BC/BS ORTHOTICS/ PROSTHET" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0020903 . This is a "NHP ORTHOTICS/ PROSTHETIC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1500007 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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