1306226022 NPI number — PONGRATZ ORTHOTICS & PROSTHETICS, INC.

Table of content: (NPI 1306226022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306226022 NPI number — PONGRATZ ORTHOTICS & PROSTHETICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PONGRATZ ORTHOTICS & PROSTHETICS, 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:
1306226022
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
730 N 52ND ST STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85008-7987
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-222-3032
Provider Business Mailing Address Fax Number:
602-222-3506

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13020 W RANCHO SANTA FE BLVD STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVONDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85392-2002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-444-8801
Provider Business Practice Location Address Fax Number:
623-455-3776
Provider Enumeration Date:
06/08/2015

Additional Information

Authorized Official

Authorized Official Last Name:
INMAN
Authorized Official First Name:
NICHOLE
Authorized Official Middle Name:
Authorized Official Title or Position:
OPERATIONS MANAGER
Authorized Official Telephone Number:
602-222-3032

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , with the licence number:  07687929 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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