1437263019 NPI number — ORTHOPEDIC TECHNOLOGIES, INC.

Table of content: (NPI 1437263019)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437263019 NPI number — ORTHOPEDIC TECHNOLOGIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPEDIC TECHNOLOGIES, 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:
1437263019
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5551 ROARING RAPIDS WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARYSVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-954-3676
Provider Business Mailing Address Fax Number:
541-967-7137

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2936 SUNBIRD DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94533-1243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-967-7100
Provider Business Practice Location Address Fax Number:
541-967-7137
Provider Enumeration Date:
08/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MASON
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
RAE
Authorized Official Title or Position:
OWNER / PROSTHETIST
Authorized Official Telephone Number:
503-580-3251

Provider Taxonomy Codes

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

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

  • Identifier: 182441 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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