1417007154 NPI number — ORTHOTIC CONCEPTS INC

Table of content: (NPI 1417007154)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417007154 NPI number — ORTHOTIC CONCEPTS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOTIC CONCEPTS 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:
1417007154
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 LIBBEY INDUSTRIAL PKWY
Provider Second Line Business Mailing Address:
SUITE 3A
Provider Business Mailing Address City Name:
WEYMOUTH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02189-3107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-340-0444
Provider Business Mailing Address Fax Number:
781-340-0486

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 LIBBEY INDUSTRIAL PKWY
Provider Second Line Business Practice Location Address:
SUITE 3A
Provider Business Practice Location Address City Name:
WEYMOUTH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02189-3107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-340-0444
Provider Business Practice Location Address Fax Number:
781-340-0486
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PATTEN
Authorized Official First Name:
WARREN
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
781-340-0444

Provider Taxonomy Codes

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

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

  • Identifier: 611001 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1535536 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 60251 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 610474 . This is a "HARVARD PILGRIM HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 110029264A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 356154 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0012446 . This is a "NEIGHBORHOOD HEALTHPLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 102857400 . This is a "ACS WORKER'S COMP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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