Provider Demographics
NPI:1437139672
Name:ORTHOTECHS O & P
Entity Type:Organization
Organization Name:ORTHOTECHS O & P
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMM
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-865-6060
Mailing Address - Street 1:3811 CENTRAL AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-8173
Mailing Address - Country:US
Mailing Address - Phone:308-865-6105
Mailing Address - Fax:
Practice Address - Street 1:3811 CENTRAL AVE
Practice Address - Street 2:SUITE F
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-8173
Practice Address - Country:US
Practice Address - Phone:308-865-6105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-21
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025161300Medicaid
NE5446880001Medicare NSC