1205931102 NPI number — ORTHOTIC & PROSTHETIC TECHNOLOGIES INC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205931102 NPI number — ORTHOTIC & PROSTHETIC TECHNOLOGIES INC

Employer Identification Number (EIN):

Provider Organization Name:

ORTHOTIC & PROSTHETIC 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 Other Organization Name:

HANGER CLINIC

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:

1205931102

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

05/10/2017

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 650846

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

DALLAS

Provider Business Mailing Address State Name:

TX

Provider Business Mailing Address Postal Code:

75265-0846

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

512-377-2323

Provider Business Mailing Address Fax Number:

512-374-9993

Provider First Line Business Practice Location Address:

8000 ANDERSON SQ

Provider Second Line Business Practice Location Address:

STE 301A

Provider Business Practice Location Address City Name:

AUSTIN

Provider Business Practice Location Address State Name:

TX

Provider Business Practice Location Address Postal Code:

78757-8421

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

512-377-2323

Provider Business Practice Location Address Fax Number:

512-374-9993

Provider Enumeration Date:

09/14/2006

Authorized Official Last Name:

ANGELINE

Authorized Official First Name:

GRACE

Authorized Official Middle Name:

Authorized Official Title or Position:

REG COMPLIANCE SPECIALIST III

Authorized Official Telephone Number:

714-961-2102

• Taxonomy code: 261QP2000X , with the licence number:  656680000 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• 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" .

• Identifier: 1049666 . This is a "CIGNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 7716547 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 10018764 . This is a "AMERIGROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 531761 . This is a "BCBS PROVIDER AUSTIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 1025407 . This is a "ACM-UNITED HEALTHCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 0042KX . This is a "BCBS PT AUSTIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 5609664 . This is a "FIRST HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 170962801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 170962802 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".