Provider Demographics
NPI:1164660999
Name:ORTHO MEDICS NORFOLK, LLC
Entity Type:Organization
Organization Name:ORTHO MEDICS NORFOLK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER/PROSTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRENDEN
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:308-216-0134
Mailing Address - Street 1:110 N 37TH ST
Mailing Address - Street 2:SUITE #403
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-3283
Mailing Address - Country:US
Mailing Address - Phone:402-371-3007
Mailing Address - Fax:402-371-3357
Practice Address - Street 1:110 N 37TH ST
Practice Address - Street 2:SUITE #403
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-3283
Practice Address - Country:US
Practice Address - Phone:402-371-3007
Practice Address - Fax:402-371-3357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NE335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE6223540001Medicare NSC