Provider Demographics
NPI:1376624593
Name:ULTRA PROSTHETICS
Entity Type:Organization
Organization Name:ULTRA PROSTHETICS
Other - Org Name:DANIEL O. HANEY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:O
Authorized Official - Last Name:HANEY
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:800-858-7576
Mailing Address - Street 1:PO BOX 22201
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89721-2201
Mailing Address - Country:US
Mailing Address - Phone:800-858-7276
Mailing Address - Fax:775-882-1561
Practice Address - Street 1:20 AFFONSO DR STE G
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-7794
Practice Address - Country:US
Practice Address - Phone:800-858-7276
Practice Address - Fax:775-882-1561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV72165335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV037033838OtherRESALE TAX NUMBER
NV003313022Medicaid
NV7435750001Medicare NSC