1851466882 NPI number — CAPSTONE ORTHOPEDIC, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851466882 NPI number — CAPSTONE ORTHOPEDIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPSTONE ORTHOPEDIC, 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:
CAPSTONE PROSTHETICS AND ORTHOTICS
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:
1851466882
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1355 BESSIE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRACY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95376-3415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-834-8600
Provider Business Mailing Address Fax Number:
209-834-8700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1355 BESSIE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRACY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95376-3415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-834-8600
Provider Business Practice Location Address Fax Number:
209-834-8700
Provider Enumeration Date:
11/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ELLIS
Authorized Official First Name:
GLEN
Authorized Official Middle Name:
STEPHEN
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
209-612-6168

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: GXC 000922 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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