Provider Demographics
NPI:1376549568
Name:ACHILLES PROSTHETICS AND ORTHOTICS, INC
Entity Type:Organization
Organization Name:ACHILLES PROSTHETICS AND ORTHOTICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:NEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:BS,, FAC, CP
Authorized Official - Phone:661-323-5944
Mailing Address - Street 1:622 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4506
Mailing Address - Country:US
Mailing Address - Phone:805-925-6144
Mailing Address - Fax:805-925-2746
Practice Address - Street 1:622 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4506
Practice Address - Country:US
Practice Address - Phone:805-925-6144
Practice Address - Fax:805-925-2746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1376549568OtherBLUE SHIELD OF MICHIGAN
CA1376549568Medicaid
TX1376549568OtherBLUE SHIELD OF TEXAS
CA1376549568OtherCALIFORNIA CHILDREN SERVICES
CA199156400OtherU.S. DEPARTMENT OF LABOR
CAZZZ82604ZOtherBLUE SHIELD
MI1376549568OtherBLUE CROSS OF MICHIGAN
CA199156400OtherU.S. DEPARTMENT OF LABOR
CA=========BOtherHEALTH NET
CA1376549568OtherCALIFORNIA CHILDREN SERVICES