Provider Demographics
NPI:1518067511
Name:O AND P SERVICES, INC
Entity Type:Organization
Organization Name:O AND P SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:PROUT
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:916-784-1612
Mailing Address - Street 1:1830 SIERRA GARDENS DR STE 40
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2942
Mailing Address - Country:US
Mailing Address - Phone:916-784-1612
Mailing Address - Fax:916-784-2182
Practice Address - Street 1:1830 SIERRA GARDENS DR STE 40
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2942
Practice Address - Country:US
Practice Address - Phone:916-784-1612
Practice Address - Fax:916-784-2182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXC0013260Medicaid
CAZZZ30683ZOtherBLUE SHIELD
CAZZZ30683ZOtherBLUE SHIELD