Provider Demographics
NPI:1679797013
Name:CAPSTONE ORTHOPEDIC, INC.
Entity Type:Organization
Organization Name:CAPSTONE ORTHOPEDIC, INC.
Other - Org Name:CUTTING EDGE ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:209-612-6168
Mailing Address - Street 1:250 COHASSET RD STE 30
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2248
Mailing Address - Country:US
Mailing Address - Phone:530-894-6400
Mailing Address - Fax:530-894-6401
Practice Address - Street 1:250 COHASSET RD STE 30
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2248
Practice Address - Country:US
Practice Address - Phone:530-894-6400
Practice Address - Fax:530-894-6401
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPSTONE ORTHOPEDIC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-13
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1679797013Medicaid
5772670005Medicare NSC