1023857505 NPI number — PONGRATZ ORTHOTICS & PROSTHETICS, INC

Table of content: (NPI 1023857505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023857505 NPI number — PONGRATZ ORTHOTICS & PROSTHETICS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PONGRATZ ORTHOTICS & PROSTHETICS, 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:
1023857505
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
730 N 52ND STREET SUITE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-222-3032
Provider Business Mailing Address Fax Number:
602-222-3506

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5880 N. LA CHOLLA BLVD SUITE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-322-4499
Provider Business Practice Location Address Fax Number:
520-322-4491
Provider Enumeration Date:
05/23/2024

Additional Information

Authorized Official

Authorized Official Last Name:
INMAN
Authorized Official First Name:
NICHOLE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
602-222-3032

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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