1154649325 NPI number — ORTHOTICS AND PROSTHETICS ASSOCIATES, INC.

Table of content: (NPI 1154649325)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154649325 NPI number — ORTHOTICS AND PROSTHETICS ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOTICS AND PROSTHETICS ASSOCIATES, 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:
6
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:
1154649325
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10506 W BLUEMOUND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53226-4332
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-257-2727
Provider Business Mailing Address Fax Number:
414-257-9898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 DELAFIELD ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
WAUKESHA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53188-3417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-436-0079
Provider Business Practice Location Address Fax Number:
262-436-0073
Provider Enumeration Date:
05/12/2010

Additional Information

Authorized Official

Authorized Official Last Name:
WOOD
Authorized Official First Name:
JAKE
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
262-436-0079

Provider Taxonomy Codes

  • Taxonomy code: 1744P3200X , with the licence number:  C.P. 1307 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 41785600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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