Provider Demographics
NPI:1366626202
Name:STREAMLINE ORTHOTICS, LLC
Entity Type:Organization
Organization Name:STREAMLINE ORTHOTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:VOGL
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:314-368-9438
Mailing Address - Street 1:615 S VANDEVENTER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1239
Mailing Address - Country:US
Mailing Address - Phone:314-289-9100
Mailing Address - Fax:
Practice Address - Street 1:615 S VANDEVENTER AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1239
Practice Address - Country:US
Practice Address - Phone:314-289-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6105850001Medicare NSC