Provider Demographics
NPI:1437384344
Name:BROWNFIELDS INC
Entity Type:Organization
Organization Name:BROWNFIELDS INC
Other - Org Name:BROWNFIELDS PROSTHETIC & ORTHOTICS TECHNOLOGIES, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:PADILLA
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:208-342-4659
Mailing Address - Street 1:1912 E FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5906
Mailing Address - Country:US
Mailing Address - Phone:208-342-4659
Mailing Address - Fax:208-342-8211
Practice Address - Street 1:847-1 PARKCENTRE WAY
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-1792
Practice Address - Country:US
Practice Address - Phone:208-342-4659
Practice Address - Fax:208-342-8211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0200540002Medicare NSC