Provider Demographics
NPI:1033689831
Name:CAPSTONE ORTHOPEDIC, INC.
Entity Type:Organization
Organization Name:CAPSTONE ORTHOPEDIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:510-537-1210
Mailing Address - Street 1:1247 E ALLUVIAL AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2686
Mailing Address - Country:US
Mailing Address - Phone:559-298-0321
Mailing Address - Fax:559-297-9033
Practice Address - Street 1:1247 E ALLUVIAL AVE STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2686
Practice Address - Country:US
Practice Address - Phone:559-298-0321
Practice Address - Fax:559-297-9033
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPSTONE ORTHOPEDIC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier