1689070823 NPI number — TAEDS ORTOTICS & PROSTHETICS

Table of content: (NPI 1689070823)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689070823 NPI number — TAEDS ORTOTICS & PROSTHETICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAEDS ORTOTICS & PROSTHETICS
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:
TAED STUDER
Provider Other Organization Name Type Code:
3
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:
1689070823
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
145 S HALCYON RD
Provider Second Line Business Mailing Address:
# B,
Provider Business Mailing Address City Name:
ARROYO GRANDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93420-3151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-710-1947
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 S HALCYON RD
Provider Second Line Business Practice Location Address:
# B,
Provider Business Practice Location Address City Name:
ARROYO GRANDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93420-3151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-710-1947
Provider Business Practice Location Address Fax Number:
805-473-8230
Provider Enumeration Date:
11/17/2014

Additional Information

Authorized Official

Authorized Official Last Name:
STUDER
Authorized Official First Name:
TAED
Authorized Official Middle Name:
Authorized Official Title or Position:
CPO / OWNER
Authorized Official Telephone Number:
805-710-1947

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X ; 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: 1346439932 . This is a "NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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