1629306352 NPI number — PRECISION ORTHOTIC & PROSTHETIC TECHNOLOGY INC

Table of content: (NPI 1629306352)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629306352 NPI number — PRECISION ORTHOTIC & PROSTHETIC TECHNOLOGY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRECISION ORTHOTIC & PROSTHETIC TECHNOLOGY 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:
1629306352
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 HANOVER ST
Provider Second Line Business Mailing Address:
SUITE 1G
Provider Business Mailing Address City Name:
FALL RIVER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02720-5444
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-991-5577
Provider Business Mailing Address Fax Number:
508-991-5505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 HANOVER ST
Provider Second Line Business Practice Location Address:
SUITE 1G
Provider Business Practice Location Address City Name:
FALL RIVER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02720-5444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-991-5577
Provider Business Practice Location Address Fax Number:
508-991-5505
Provider Enumeration Date:
11/18/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HEBERT
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
508-991-5577

Provider Taxonomy Codes

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

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

  • Identifier: AA33007 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: OWCP . This is a "610047000" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 400554 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 00000029723 . This is a "BMC HEALTHNET" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1528271 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 642391 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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