Provider Demographics
NPI:1417558404
Name:ORTHOWEST
Entity Type:Organization
Organization Name:ORTHOWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:BRYCE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-586-3200
Mailing Address - Street 1:PO BOX 45928
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-5928
Mailing Address - Country:US
Mailing Address - Phone:714-241-7000
Mailing Address - Fax:
Practice Address - Street 1:710 N EUCLID ST STE 201
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-4122
Practice Address - Country:US
Practice Address - Phone:714-241-7000
Practice Address - Fax:714-241-7003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-05
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies