1215168398 NPI number — MAUGHAN PROSTHETIC & ORTHOTIC, INC.

Table of content: (NPI 1215168398)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215168398 NPI number — MAUGHAN PROSTHETIC & ORTHOTIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAUGHAN PROSTHETIC & ORTHOTIC, 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:
1215168398
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1546
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAHAM
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98338-1546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-447-0770
Provider Business Mailing Address Fax Number:
253-904-8705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10689 OLD FRONTIER RD NW STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SILVERDALE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98383-9040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-698-2229
Provider Business Practice Location Address Fax Number:
360-698-0122
Provider Enumeration Date:
08/06/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MAUGHAN
Authorized Official First Name:
JUSTIN
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
PRESIDENT/CPO
Authorized Official Telephone Number:
253-820-3689

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , with the licence number:  PS00000183 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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