1912386046 NPI number — ANACORTES PROSTHETICS & ORTHOTICS LLC

Table of content: (NPI 1912386046)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912386046 NPI number — ANACORTES PROSTHETICS & ORTHOTICS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANACORTES PROSTHETICS & ORTHOTICS LLC
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:
1912386046
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2801 COMMERCIAL AVE
Provider Second Line Business Mailing Address:
SUITE 5
Provider Business Mailing Address City Name:
ANACORTES
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98221-2700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-587-0055
Provider Business Mailing Address Fax Number:
360-587-0077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2801 COMMERCIAL AVE
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
ANACORTES
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98221-2700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-587-0055
Provider Business Practice Location Address Fax Number:
360-587-0077
Provider Enumeration Date:
05/21/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHASE
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
Authorized Official Title or Position:
PROSTHETIST/ ORTHOTIST
Authorized Official Telephone Number:
360-587-0055

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  PS00000351 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2500X , with the licence number: OI00000342 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2048222 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1154648012 . This is a "PERSONAL NPI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0342611 . This is a "LABOR AND INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".