1821109679 NPI number — DISTRICT ORTHOPEDIC APPLIANCES, INC

Table of content: (NPI 1821109679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821109679 NPI number — DISTRICT ORTHOPEDIC APPLIANCES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DISTRICT ORTHOPEDIC APPLIANCES, 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:
1821109679
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7702 BACKLICK RD., SUITE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-698-7373
Provider Business Mailing Address Fax Number:
703-698-7374

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7702 BACKLICK RD., SUITE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-698-7373
Provider Business Practice Location Address Fax Number:
703-698-7374
Provider Enumeration Date:
08/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GUARRASI
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CERTIFIED PROSTHETIST/ORTHOTIST CPO
Authorized Official Telephone Number:
703-698-7373

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • 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: 188916 . This is a "AMERIGROUP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 009190520 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 23521 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 031668900 . This is a "PROSTHETICS/ORTHOTICS/THERAPUETIC FOOTWEAR" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: MG64 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4523 . This is a "HEALTH RIGHT" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 291468 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 258901000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: F604 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".