1376619361 NPI number — HANGER PROSTHETICS & ORTHOTICS INC

Table of content: (NPI 1376619361)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376619361 NPI number — HANGER PROSTHETICS & ORTHOTICS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HANGER PROSTHETICS & 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:
6
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:
1376619361
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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:
941-365-7588
Provider Business Mailing Address Fax Number:
941-366-8513

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1838 HILLVIEW ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34239-3605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-365-7588
Provider Business Practice Location Address Fax Number:
941-366-8513
Provider Enumeration Date:
11/28/2006

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • 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" .

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

  • Identifier: M0511 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 027717700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50665 . This is a "AMERICAN BENEFIT PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50666 . This is a "NORTHWOOD NPN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010247000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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