Provider Demographics
NPI:1164621926
Name:INSTRIDE VENTURES LLC
Entity Type:Organization
Organization Name:INSTRIDE VENTURES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WERREMEYER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:866-969-3338
Mailing Address - Street 1:100 N WILKES BARRE BLVD
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-5253
Mailing Address - Country:US
Mailing Address - Phone:866-969-3338
Mailing Address - Fax:908-359-7434
Practice Address - Street 1:100 N WILKES BARRE BLVD
Practice Address - Street 2:4TH FLOOR
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-5253
Practice Address - Country:US
Practice Address - Phone:866-969-3338
Practice Address - Fax:908-359-7434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier