1922863117 NPI number — PATRIOT PROSTHETICS AND ORTHOTICS, INC.

Table of content: (NPI 1922863117)

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)





Copyright © 2007-2025 www.npivalidator.com