Provider Demographics
NPI:1255866968
Name:NORTH BAY PROSTHETICS AND ORTHOTICS LLC
Entity Type:Organization
Organization Name:NORTH BAY PROSTHETICS AND ORTHOTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-724-8985
Mailing Address - Street 1:671 ELMIRA RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-4655
Mailing Address - Country:US
Mailing Address - Phone:707-724-8985
Mailing Address - Fax:707-724-8986
Practice Address - Street 1:671 ELMIRA RD
Practice Address - Street 2:SUITE 120
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-4655
Practice Address - Country:US
Practice Address - Phone:707-724-8985
Practice Address - Fax:707-724-8986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-01
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier