Provider Demographics
NPI:1275667701
Name:ORTHOTIC PROSTHETIC ASSOCIATES INC
Entity Type:Organization
Organization Name:ORTHOTIC PROSTHETIC ASSOCIATES INC
Other - Org Name:COLUMBIA ORTHOPEDIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CERTIFIED PROSTHETIST ORTHOTIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:A
Authorized Official - Last Name:JANKE
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:503-252-5100
Mailing Address - Street 1:173A NE 102ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-4176
Mailing Address - Country:US
Mailing Address - Phone:503-252-5100
Mailing Address - Fax:503-253-8086
Practice Address - Street 1:173A NE 102ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4176
Practice Address - Country:US
Practice Address - Phone:503-252-5100
Practice Address - Fax:503-253-8086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORNONE332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR229263Medicaid
OR229263Medicaid