1093993222 NPI number — SOUTH COAST ORTHOPEDIC TECHNOLOGIES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093993222 NPI number — SOUTH COAST ORTHOPEDIC TECHNOLOGIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH COAST ORTHOPEDIC TECHNOLOGIES, 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:
1093993222
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
535 FAUNCE CORNER RD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
NORTH DARTMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02747-1242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-998-7268
Provider Business Mailing Address Fax Number:
508-998-7267

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
535 FAUNCE CORNER RD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
NORTH DARTMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02747-1242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-998-7268
Provider Business Practice Location Address Fax Number:
508-998-7267
Provider Enumeration Date:
02/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PENNEY
Authorized Official First Name:
RANDY
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
508-998-7268

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)





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