Provider Demographics
NPI:1144378142
Name:ANDERS ORTHOPEDIC PROSTHETIC INC
Entity Type:Organization
Organization Name:ANDERS ORTHOPEDIC PROSTHETIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:DIETER
Authorized Official - Last Name:ANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-461-4279
Mailing Address - Street 1:1825 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-3403
Mailing Address - Country:US
Mailing Address - Phone:323-461-4279
Mailing Address - Fax:323-461-4279
Practice Address - Street 1:1825 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-3403
Practice Address - Country:US
Practice Address - Phone:323-461-4279
Practice Address - Fax:323-461-4279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXA0009990Medicaid
CAXA0009990Medicaid
CA0378470001Medicare UPIN
CA0378470001Medicare NSC