1225033145 NPI number — THE ORTHOPEDIC STORE

Table of content: (NPI 1225033145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225033145 NPI number — THE ORTHOPEDIC STORE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE ORTHOPEDIC STORE
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:
1225033145
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 792590
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78279-2590
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-366-2990
Provider Business Mailing Address Fax Number:
210-499-4984

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1211 ARION PKWY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78216-2808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-366-2990
Provider Business Practice Location Address Fax Number:
210-499-4984
Provider Enumeration Date:
06/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HARIG
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
RANDOLPH
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
210-366-2990

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  643020000 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1446635-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0040GZ . This is a "BCBS OF TEXAS-PT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 643020000 . This is a "TEXAS BOARD OF PHYSICAL THERAPY EXAMINERS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1446627-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com