Provider Demographics
NPI:1629476510
Name:RESTORE MEDICAL, INC.
Entity Type:Organization
Organization Name:RESTORE MEDICAL, INC.
Other - Org Name:RESTORE ORTHOTICS AND PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUNPHY
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:530-605-4292
Mailing Address - Street 1:2147 COURT ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2531
Mailing Address - Country:US
Mailing Address - Phone:530-605-4292
Mailing Address - Fax:530-605-4296
Practice Address - Street 1:2160 COURT ST STE B
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2544
Practice Address - Country:US
Practice Address - Phone:530-605-4292
Practice Address - Fax:530-605-4296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3643241Medicaid