Provider Demographics
NPI:1003118050
Name:EDDIE ZEPEDA
Entity Type:Organization
Organization Name:EDDIE ZEPEDA
Other - Org Name:PRIMECARE ORTHOTICS & PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CERTIFIED ORTHOTIST/PROSTHETIS
Authorized Official - Prefix:
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEPEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-523-2273
Mailing Address - Street 1:1401 S DON ROSER DR
Mailing Address - Street 2:SUITE E2
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4567
Mailing Address - Country:US
Mailing Address - Phone:575-523-2273
Mailing Address - Fax:575-526-2068
Practice Address - Street 1:1401 S DON ROSER DR STE E2
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4576
Practice Address - Country:US
Practice Address - Phone:575-523-2273
Practice Address - Fax:575-526-2068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-24
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM09176071Medicaid
2131956OtherPK
6205020001Medicare NSC