Provider Demographics
NPI:1225208481
Name:WINN'S ORTHOTICS & PROSTHETICS
Entity Type:Organization
Organization Name:WINN'S ORTHOTICS & PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:COLE
Authorized Official - Last Name:WINN
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:480-982-3000
Mailing Address - Street 1:1075 S IDAHO RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85219-6496
Mailing Address - Country:US
Mailing Address - Phone:480-982-3000
Mailing Address - Fax:480-982-3103
Practice Address - Street 1:1075 S IDAHO RD
Practice Address - Street 2:SUITE 101
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85219-6496
Practice Address - Country:US
Practice Address - Phone:480-982-3000
Practice Address - Fax:480-982-3103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1744P3200X
AZCPO02652332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5813300001Medicare NSC