Provider Demographics
NPI:1124198114
Name:CHANNEL ISLANDS PROSTHETICS,INC
Entity Type:Organization
Organization Name:CHANNEL ISLANDS PROSTHETICS,INC
Other - Org Name:CHANNEL ISLANDS PROSTHETICS-ORTHOTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:MCATEE
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:805-658-1822
Mailing Address - Street 1:520 W 5TH ST
Mailing Address - Street 2:STE A
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-7025
Mailing Address - Country:US
Mailing Address - Phone:805-486-5531
Mailing Address - Fax:805-658-1824
Practice Address - Street 1:520 W 5TH ST
Practice Address - Street 2:STE A
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-7025
Practice Address - Country:US
Practice Address - Phone:805-486-5531
Practice Address - Fax:805-658-1824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXB0013520Medicaid
CA0437170001Medicare ID - Type Unspecified