Provider Demographics
NPI:1366026312
Name:ARTISAN ORTHOTIC PROSTHETIC TECHNOLOGIES, INC
Entity Type:Organization
Organization Name:ARTISAN ORTHOTIC PROSTHETIC TECHNOLOGIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUMGARTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-391-7307
Mailing Address - Street 1:1710 WILLOW CREEK CIR STE 1
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-9192
Mailing Address - Country:US
Mailing Address - Phone:877-353-0545
Mailing Address - Fax:
Practice Address - Street 1:1813 W HARVARD AVE STE 101
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-2752
Practice Address - Country:US
Practice Address - Phone:877-353-0545
Practice Address - Fax:541-391-7308
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARTISAN ORTHOTIC PROSTHETIC TECHNOLOGIES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-06
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier