Provider Demographics
NPI:1255664165
Name:NEVADA ORTHOTICS & PROSTHETICS, INC
Entity Type:Organization
Organization Name:NEVADA ORTHOTICS & PROSTHETICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PETRA
Authorized Official - Middle Name:
Authorized Official - Last Name:THIESSEN
Authorized Official - Suffix:
Authorized Official - Credentials:CFM
Authorized Official - Phone:702-233-5500
Mailing Address - Street 1:3435 W CHEYENNE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-8206
Mailing Address - Country:US
Mailing Address - Phone:702-233-5500
Mailing Address - Fax:702-233-2131
Practice Address - Street 1:3435 W CHEYENNE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-8206
Practice Address - Country:US
Practice Address - Phone:702-233-5500
Practice Address - Fax:702-233-2131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1255664165Medicaid
DECPO02365OtherAMERICAN BOARD FOR CERTIFICATION IN ORTHOTICS AND PROSTHETICS INC.
NVMP00636OtherNEVADA STATE BOARD OF PHARMACY, MEDICAL DEVICES, EQUIPTMENT, GAS LICENSE
DECPO02365OtherAMERICAN BOARD FOR CERTIFICATION IN ORTHOTICS AND PROSTHETICS INC.