Provider Demographics
NPI:1003058595
Name:PROSTHETIC CONSULTING TECHNOLOGIES LLC
Entity Type:Organization
Organization Name:PROSTHETIC CONSULTING TECHNOLOGIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:775-830-1783
Mailing Address - Street 1:220 US HIGHWAY 395 N
Mailing Address - Street 2:SUITE 303
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89704-9582
Mailing Address - Country:US
Mailing Address - Phone:775-849-0958
Mailing Address - Fax:775-849-2566
Practice Address - Street 1:220 US HIGHWAY 395 N
Practice Address - Street 2:SUITE 303
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89704-9582
Practice Address - Country:US
Practice Address - Phone:775-849-0958
Practice Address - Fax:775-849-2566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1003058595Medicaid
NV1003058595Medicaid