Provider Demographics
NPI:1689180564
Name:AMNIOTIC SURGICAL INNOVATIONS, INC
Entity Type:Organization
Organization Name:AMNIOTIC SURGICAL INNOVATIONS, INC
Other - Org Name:ORTHOMED MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-663-2821
Mailing Address - Street 1:777 N GROVE RD STE 115
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-2760
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:777 N GROVE RD STE 115
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-2760
Practice Address - Country:US
Practice Address - Phone:214-663-2821
Practice Address - Fax:214-466-1199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies