Provider Demographics
NPI:1760989313
Name:NORTH BAY PROSTHETICS AND ORTHOTICS LLC
Entity Type:Organization
Organization Name:NORTH BAY PROSTHETICS AND ORTHOTICS LLC
Other - Org Name:RIVER CITY PROSTHETICS AND ORTHOTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-425-5028
Mailing Address - Street 1:450 CHADBOURNE RD STE B
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-9612
Mailing Address - Country:US
Mailing Address - Phone:707-425-5028
Mailing Address - Fax:707-425-5029
Practice Address - Street 1:5900 COYLE AVE STE B
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0400
Practice Address - Country:US
Practice Address - Phone:916-349-7600
Practice Address - Fax:916-349-7606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier