Provider Demographics
NPI:1205026960
Name:AMPRO ORTHOTICS & PROSTHETICS INC
Entity Type:Organization
Organization Name:AMPRO ORTHOTICS & PROSTHETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKES-JARVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-457-3200
Mailing Address - Street 1:6877 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-0008
Mailing Address - Country:US
Mailing Address - Phone:702-457-3200
Mailing Address - Fax:702-457-0908
Practice Address - Street 1:921 S. HIGHWAY 160
Practice Address - Street 2:SUITE 203
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048
Practice Address - Country:US
Practice Address - Phone:877-457-3200
Practice Address - Fax:702-457-0908
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMPRO ORTHOTICS & PROSTHETICS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-30
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV0638490003Medicare NSC