Provider Demographics
NPI:1003150210
Name:ELITE BIOMECHANICAL DESIGN
Entity Type:Organization
Organization Name:ELITE BIOMECHANICAL DESIGN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:BOCO
Authorized Official - Phone:530-894-6913
Mailing Address - Street 1:1100 GARDEN HWY
Mailing Address - Street 2:SUITE 900
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-7592
Mailing Address - Country:US
Mailing Address - Phone:530-673-6913
Mailing Address - Fax:530-671-6915
Practice Address - Street 1:1100 GARDEN HWY
Practice Address - Street 2:SUITE 900
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-7592
Practice Address - Country:US
Practice Address - Phone:530-673-6913
Practice Address - Fax:530-671-6915
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELITE BIOMECHANICAL DESIGN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-12
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6344970003Medicare NSC