Provider Demographics
NPI:1043758196
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 1:5878 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-4840
Mailing Address - Country:US
Mailing Address - Phone:530-762-2987
Mailing Address - Fax:530-762-4963
Practice Address - Street 1:5878 CLARK RD
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-4840
Practice Address - Country:US
Practice Address - Phone:530-762-2987
Practice Address - Fax:530-762-4963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier