Provider Demographics
NPI:1033534748
Name:WILLAMETTE ORTHOTICS & PROSTHETICS, LLC
Entity Type:Organization
Organization Name:WILLAMETTE ORTHOTICS & PROSTHETICS, LLC
Other - Org Name:SUMMIT ORTHOTICS & PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-364-6006
Mailing Address - Street 1:PO BOX 7339
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97303-0102
Mailing Address - Country:US
Mailing Address - Phone:503-364-6006
Mailing Address - Fax:503-364-6046
Practice Address - Street 1:903 9TH AVE SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-2420
Practice Address - Country:US
Practice Address - Phone:541-967-7100
Practice Address - Fax:541-967-7137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment