1457431686 NPI number — CREATIVE ORTHOTICS & PROSTHETICS, INC.

Table of content: (NPI 1457431686)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457431686 NPI number — CREATIVE ORTHOTICS & PROSTHETICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CREATIVE 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:
1457431686
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2014
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:
607-771-4672
Provider Business Mailing Address Fax Number:
607-722-0533

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
65 PENNSYLVANIA AVE
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
BINGHAMTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13903-1608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-771-4672
Provider Business Practice Location Address Fax Number:
607-722-0533
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PRICE
Authorized Official First Name:
SHERYL
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF REIMBURSEMENT
Authorized Official Telephone Number:
503-493-8288

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: 02432222 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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