Provider Demographics
NPI:1417494501
Name:PREMIER ORTHOTICS INC
Entity Type:Organization
Organization Name:PREMIER ORTHOTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPPELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-761-4299
Mailing Address - Street 1:101 S REID ST
Mailing Address - Street 2:SUITE 307 PMB V360
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-7030
Mailing Address - Country:US
Mailing Address - Phone:678-761-4299
Mailing Address - Fax:
Practice Address - Street 1:101 S REID ST
Practice Address - Street 2:SUITE 307 PMB V360
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-7030
Practice Address - Country:US
Practice Address - Phone:678-761-4299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies