1558398750 NPI number — ADVANCE ORTHOTIC & PROSTHETIC SERVICES, INC.

Table of content: (NPI 1558398750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558398750 NPI number — ADVANCE ORTHOTIC & PROSTHETIC SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCE ORTHOTIC & PROSTHETIC SERVICES, 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:
1558398750
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 NORTH RIVER ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUBURN
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-786-7022
Provider Business Mailing Address Fax Number:
207-777-1787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 N RIVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04210-9479
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-786-7022
Provider Business Practice Location Address Fax Number:
207-777-1787
Provider Enumeration Date:
06/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
207-786-7022

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: 132230000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 132230001 . This is a "MAINECARE" identifier . This identifiers is of the category "OTHER".




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