Provider Demographics
NPI:1568651131
Name:ADVANCED ORTHOPEDIC DESIGNS, LLC
Entity Type:Organization
Organization Name:ADVANCED ORTHOPEDIC DESIGNS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:ONEILL
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:503-407-5408
Mailing Address - Street 1:12315 JUDSON RD STE 206
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3264
Mailing Address - Country:US
Mailing Address - Phone:210-657-8100
Mailing Address - Fax:210-657-8105
Practice Address - Street 1:12315 JUDSON RD STE 206
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3264
Practice Address - Country:US
Practice Address - Phone:210-657-8100
Practice Address - Fax:210-657-8105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101234335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188298702Medicaid
TX188298701Medicaid