Provider Demographics
NPI:1285632034
Name:ORTHOPRO OF CARSON CITY, INC.
Entity Type:Organization
Organization Name:ORTHOPRO OF CARSON CITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:775-841-0660
Mailing Address - Street 1:415 W SOPHIA ST
Mailing Address - Street 2:SUITE #200
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-8804
Mailing Address - Country:US
Mailing Address - Phone:775-841-0660
Mailing Address - Fax:775-841-0606
Practice Address - Street 1:415 W SOPHIA ST
Practice Address - Street 2:SUITE #200
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-8804
Practice Address - Country:US
Practice Address - Phone:775-841-0660
Practice Address - Fax:775-841-0606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CPO 01406335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100502019Medicaid
NV4990070001Medicare NSC