1376549568 NPI number — ACHILLES PROSTHETICS AND ORTHOTICS, INC

Table of content: (NPI 1376549568)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376549568 NPI number — ACHILLES PROSTHETICS AND ORTHOTICS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACHILLES PROSTHETICS AND ORTHOTICS, 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:
1376549568
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
622 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA MARIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93454-4506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-925-6144
Provider Business Mailing Address Fax Number:
805-925-2746

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
622 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA MARIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93454-4506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-925-6144
Provider Business Practice Location Address Fax Number:
805-925-2746
Provider Enumeration Date:
06/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
NEWTON
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
661-323-5944

Provider Taxonomy Codes

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

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

  • Identifier: 1376549568 . This is a "BLUE SHIELD OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1376549568 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1376549568 . This is a "BLUE SHIELD OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1376549568 . This is a "CALIFORNIA CHILDREN SERVICES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 199156400 . This is a "U.S. DEPARTMENT OF LABOR" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ82604Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1376549568 . This is a "BLUE CROSS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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