1922863117 NPI number — PATRIOT PROSTHETICS AND ORTHOTICS, 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 1922863117 NPI number — PATRIOT PROSTHETICS AND ORTHOTICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATRIOT PROSTHETICS AND ORTHOTICS, 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:
1922863117
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1804 COMMONS CIR STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YUKON
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73099-9525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-577-6778
Provider Business Mailing Address Fax Number:
405-577-6799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2305 S I 35 SERVICE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOORE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73160-2775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-703-1472
Provider Business Practice Location Address Fax Number:
405-703-1653
Provider Enumeration Date:
02/16/2024

Additional Information

Authorized Official

Authorized Official Last Name:
HUGGINS
Authorized Official First Name:
MICHELE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE ADMINISTRATOR
Authorized Official Telephone Number:
405-577-6778

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)





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