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?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier