Provider Demographics
NPI: | 1407275852 |
---|---|
Name: | ADVANCED PROSTHETICS AND ORTHOTICS |
Entity Type: | Organization |
Organization Name: | ADVANCED PROSTHETICS AND ORTHOTICS |
Other - Org Name: | ADVANCED O&P |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | AR MANAGER |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | BRIDGET |
Authorized Official - Middle Name: | RENEE |
Authorized Official - Last Name: | DALY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 573-441-0744 |
Mailing Address - Street 1: | 1101 LAKEVIEW AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | COLUMBIA |
Mailing Address - State: | MO |
Mailing Address - Zip Code: | 65201-4659 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 573-441-0744 |
Mailing Address - Fax: | 573-441-0745 |
Practice Address - Street 1: | 802 MIDPOINT DR |
Practice Address - Street 2: | |
Practice Address - City: | O FALLON |
Practice Address - State: | MO |
Practice Address - Zip Code: | 63366-5945 |
Practice Address - Country: | US |
Practice Address - Phone: | 573-441-0744 |
Practice Address - Fax: | 573-441-0745 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | MID MISSOURI ORTHOTICS AND PROSTHETICS |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2014-04-14 |
Last Update Date: | 2014-04-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 335E00000X | Suppliers | Prosthetic/Orthotic Supplier |