Provider Demographics
NPI:1508396326
Name:ORTHOPEDIC TOE GUARD
Entity Type:Organization
Organization Name:ORTHOPEDIC TOE GUARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:GALVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-368-8637
Mailing Address - Street 1:611 OCEAN AVE # 100
Mailing Address - Street 2:
Mailing Address - City:MANZANITA
Mailing Address - State:OR
Mailing Address - Zip Code:97130-9060
Mailing Address - Country:US
Mailing Address - Phone:503-368-8637
Mailing Address - Fax:
Practice Address - Street 1:611 OCEAN AVE.
Practice Address - Street 2:PO BOX100
Practice Address - City:MANZANITA
Practice Address - State:OR
Practice Address - Zip Code:97130-0100
Practice Address - Country:US
Practice Address - Phone:503-368-8637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment