Provider Demographics
NPI:1740399989
Name:ARTISAN ORTHOTIC PROSTHETIC TECHNOLOGIES INC
Entity Type:Organization
Organization Name:ARTISAN ORTHOTIC PROSTHETIC TECHNOLOGIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-353-0545
Mailing Address - Street 1:1720 WILLOW CREEK CIR STE 525B
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-9171
Mailing Address - Country:US
Mailing Address - Phone:877-353-0545
Mailing Address - Fax:
Practice Address - Street 1:1720 WILLOW CREEK CIR STE 525B
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-9171
Practice Address - Country:US
Practice Address - Phone:877-353-0545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR300571301OtherREGENCE BC BS
4901080001Medicare ID - Type Unspecified
OR300571301OtherREGENCE BC BS